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Train with Darrell

The Darrell Green Speed Enhancement for Youth Huddle is a private session that provides one-on-one training and personal demonstrations by Darrell of every concept, technique, and skill he will use during the session. Register Now!

* Required Fields

General Information

*Youth Last Name:

*First:

*Middle:

*Age:

*Grade:

*School:

*Parent/Guardian Name 1:

*Parent/Guardian Name 2:

*Day Phone:

*Email:

*Mailing Address 1:

Address 2:

*City:

*State:	*Zip:

Physical Information

Height:

feet inches

Weight:

lbs.

Date of Last Physical:

/ / (mm/dd/yy)

T-Shirt Size:

Favorite Athletic Activities (list all):

Huddle Information

*Date of Huddle/First Choice:

/ / (mm/dd/yy)

*Date of Huddle/Second Choice:

/ / (mm/dd/yy)

*Date of Huddle/Third Choice:

/ / (mm/dd/yy)

How did you hear about this program?

Health Information

Does your child have any preexisting health conditions that could impact his/her ability to participate in physical activities?

Yes No

If yes, please list all:

Does your child suffer from any allergies, including food allergies?

Yes No

If yes, please list all:

Does your child have asthma or any other respiratory diseases?

Yes No

If yes, please list all:

Has your child suffered from any of the following conditions in the past four (4) weeks? Please check all that apply:

Cold

Flu

Severe Headache

Nosebleed

Ear Ache

Stomach Ache

Asthma Attack

Muscle Injury

Sprain

Other

Is your child currently taking any medication?

Yes No

If yes, please list all:

Emergency Contact Information

*Contact 1 First Name:

*Contact 1 Last Name:

*Contact 2 First Name:

*Contact 2 Last Name:

*Contact 1 Phone:

*Relationship to Participant:

*Contact 2 Phone:

*Relationship to Participant:

General Release

*I understand items brought to the Huddle are the responsibility of my child(ren) and I do not hold Darrell Green Enterprises nor any of its associates, sponsors, vendors, advertisers, consultants or any other organization affiliated with the Darrell Green Speed Enhancement for Youth Huddle responsible for lost or stolen items.

Agree Disagree

*I understand photos are taken of the Darrell Green Speed Enhancement for Youth Huddle and that Darrell Green Enterprises, LLC might use these photos for promotional use in printed materials and on www.DarrellGreen.com.

Agree Disagree

Participation Agreement

*I understand that my child(ren) must abide by the rules and regulations set forth during the Huddle and that my child(ren) is subject to dismissal without reimbursement or recourse should a violation occur or should my child(ren) otherwise jeopardize their safety and/or the safety of other participants.

Agree Disagree

*I further understand that my child(ren) will not be permitted to leave the premises for any reason other than a medical emergency or pre-approved authorized early departure prior to the end of the training session.

Agree Disagree

Medical Consent

*I confirm that my child(ren) is in good health and is current on all immunizations as mandated by the State of Virginia, State of Maryland or District of Columbia. I grant permission for my child(ren) to fully participate in the Darrell Green Speed Enhancement for Youth Huddle and hereby attest that, to the best of my knowledge, my child(ren) is able to perform aerobic, calisthenic, cardiovascular, strength, flexibility and other exercises.

Agree Disagree

*I understand that I will be contacted in the event of an accident and/or injury. However, in the event I cannot be reached, I hereby authorize representatives of Darrell Green Enterprises, LLC to act for me, according to their best judgement, in any emergency requiring medical attention, and consent to examination and treatment of my child(ren) by a qualified physician and/or hospital emergency room.

Agree Disagree

Waiver

*I understand that neither Darrell Green Enterprises nor any of its associates, sponsors, vendors, advertisers, consultants or any other organization affiliated with the Darrell Green Speed Enhancement for Youth Huddle will assume any responsibility and will not be held liable for any accident arising from my child(ren)’s participation in the Darrell Green Speed Enhancement for Youth Huddle that results in medical, dental or other expenses. I further agree to assume sole responsibility for payment of any and all medical, dental, or other expenses incurred as a result of injury or sickness, and hereby release and discharge Darrell Green Enterprises, LLC and any of its associates, sponsors, vendors, advertisers, consultants or any other organization affiliated with the Darrell Green Speed Enhancement for Youth Huddle and their offices, agents and employees from and against any and all liability or cause of action arising from or in connection with my child(ren)’s participation.

Agree Disagree

Payment Terms

The cost of each huddle is $300 per child plus a $50 nonrefundable registration fee. Registrations may be cancelled one week prior to the registered huddle date for a full refund or rescheduled for a later session. Registrations cancelled less than one week prior to the scheduled huddle date that are not rescheduled will receive a 75% refund of the $300 fee.

Participants are welcome to attend more than one session and can register for more than one session at the same time. The registration fee for private groups of 10 children is $25 per child.