Let’s work together.Interested in working together? Fill out some info and we will be in touch shortly! We can't wait to hear from you! Name * First Name Last Name Email * Phone * (###) ### #### Fees With Video (Kicking Lessons) 60 Minute Evaluation - $125 90 Minute Session (Single) - $175 2 Hour Session - $250 90 Minute Session (Pack of 3) - $475 Fees Without Video (Kicking Lessons) 60 Minute Evaluation - $115 90 Minute Session (Single) - $150 2 Hour Session - $230 90 Minute Lesson (Pack of 3) - $400 Strength Training 60 Minute Session - $75 90 Minute Session - $100 60 Minute Session (Pack of 3) - $210 60 Minute Session (Pack of 5) - $350 Insured By: * Policy Number * Do you have any physical restrictions, medical issues, allergies and/or medication requirements? * Yes No If yes, please describe in the box below: Media Release? * Yes No HOLD HARMLESS AGREEMENT * Coach Zauner, LLC Consent, Waiver and Hold Harmless Agreement: I understand and agree to the procedures and conditions requested by Coach Zauner, LLC for registrations, deposits and refunds as stated on the Coach Zauner, LLC Fee Sheet. I understand the Coach Zauner, LLC Programs are for instructional and training purposes, and I understand they stress repetitious training in specific sports skills. I acknowledge that at Coach Zauner, LLC Programs as a participant I/my son/ward will participate in an activity that may involve, among other things, physical contact of the body with other persons or objects, including the ground, and at Coach Zauner, LLC Programs I/my son/ward may incur a risk of injury. I attest and verify that I/my son/ward to be physically fit and have sufficiently trained to participate in this instruction. All Coach Zauner, LLC participants are required to be covered by personal medical insurance which must, be provided to Coach Zauner, LLC prior to participating. Providing insurance information is for the protection of all participants, parents/guardians and Coach Zauner, LLC in the event of any type of emergency. If you, or your son or ward will be under the age of 18 years while attending Coach Zauner, LLC Programs it is our policy to secure your consent for medical treatment. In case of illness or injury, permission is granted to have the participant treated at an appropriate medical facility. By signing below, you are giving consent in advance for medical treatment. As a participant in the Coach Zauner, LLC Programs I hereby state that I am aware of and accept the risk inherent in the program activities. I understand that Coach Zauner, LLC may take photographs/video of Coach Zauner, LLC Program participants and related activities. I agree Coach Zauner, LLC shall be the owner of these photographs/video and may use said photographs/videos in the promotion of all Coach Zauner, LLC related projects. (Participants accept responsibility to check with their athletic director or coach for questions regarding eligibility.) The undersigned does hereby agree to hold harmless and indemnify Coach Zauner LLC, Counselors, Coaches, Assistants, Employees or Owners, from any and all liability of injury, loss, damages, costs or expenses which are sustained, incurred or required arising out of the action of dependent/participant in the course of traveling to and from or participating in Coach Zauner, LLC Programs. I acknowledge that I have read and fully understand this Coach Zauner, LLC Consent, Waiver and Hold Harmless Agreement. YOU HEREBY CERTIFY THAT YOU HAVE READ THIS DOCUMENT AND THAT YOU FULLY UNDERSTAND ITS CONTENT. YOU ARE AWARE THAT THIS IS A RELEASE AND WAIVER OF LIABILITY AND A CONTRACT. YOU HEREBY VOLUNTARILY SIGN IT OF YOUR OWN FREE WILL. By completing and submitting this registration you are in agreement and accept the terms of the Coach Zauner, LLC Consent, Waiver and Hold Harmless Agreement and Coach Zauner LLC COVID-19 Liability Release Form ('Yes' must be checked by all registrants wishing to participate in any Coach Zauner, LLC Program): I AGREE Thank you! I will be in contact with you to schedule our session(s) shortly! Have a great day!
