Participant's First Name (required)

Participant's Last Name (required)

Participant's or Parent's Email (required)

Participant's or Parent's Phone Number (required)

Participant's Age (required)

Clinic Date Attending (required)

Emergency Contact (required)

Medical Notes or Allergies

WAIVER: I, the parent and/or guardian of the above named applicant, hereby give my approval to said applicant’s participation in the Hawaii Speed and Quickness camp. I assume all risks and hazards incidental to all participation and do forever RELEASE, acquit, discharge, and covenant to hold harmless Hawaii Speed and Quickness, Inc., Rich Miano, Brick House Training, Chad Ikei Training any volunteers, and their representatives, from any and all liability from any and all actions, causes of action, and claims for any injury or damage, and any and all liability for any such injury or damage. I hereby authorize the personnel of Hawaii Speed & Quickness to take any necessary steps for the required medical treatment for said child/ward. I hereby release Hawaii Speed & Quickness and its personnel from any and all liability for any medical treatment decisions made for the treatment of said minor child/ward.

Upcoming Schedule

Mid-Pacific Gym and Field
Saturdays 8 am – 9:15 am
Registration starts at 7:30 @ gym

$5per session for all Mid-Pacific students with school ID
NOTE: This clinic is open to the public at the normal rate of $10 per participant.

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