Coach Derek Foremost Youth Sports Training -Teaching Athletic Skills and Life Lessons to Kids 2-14
The Premiere Youth Sports Program for Boys & Girls Ages 2-14
 
Special Event / Private Lesson Form

Instructions: PLEASE READ BEFORE YOU FILL OUT. AND FILL OUT FORM COMPLETELY



Event Type
 Parent's Name
Home Phone
 Mobile Phone
Email
 Day of the week
Child's Name
 Child's DOB
Mailing Address
 Payment Type
  Time
Age Range of Participants
Coach Preference
Sport(s)
 Location

Please describe your event below:
Comments

By hitting the submit button you agree to the follow Coach Derek's policy.

I, the undersigned participant, parent, or guardian, do hereby agree to participate and/or allow the individual(s) named herein to participate in the aforementioned activity(ies) and further agree to indemnify and hold harmless Coach Derek, Inc., its agents and employees from harm, accidents, personal injury or property damage which may be suffered by the aforementioned individual(s) arising out of, or in any way connected with the participation of the activity.



Register online and MAIL PAYMENT TO: Derek Locklear, 2711 N Sepulveda Blvd #211, Manhattan Beach, CA 90266-2725

(Checks payable to Coach Derek, Inc.)

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