COACH ZAUNER, LLC
ONLINE REGISTRATION FORM

PLEASE COMPLETE FOR ALL COACH ZAUNER PROGRAMS

SELECT A COACH ZAUNER PROGRAM:

COLLEGE SENIOR SPECIALISTS COMBINE
EVALUATION TO QUALIFY FOR FREE AGENT SPECIALISTS COMBINE
FREE AGENT SPECIALISTS COMBINE
ONE ON ONE LESSONS
EVALUATIONS

    PRO DEVELOPMENT CAMPS 2010
     May 21-23 ARIZONA PRO DEVELOPMENT CAMP
     June 25-27 MINNESOTA PRO DEVELOPMENT CAMP
     July 23-25  MINNESOTA PRO DEVELOPMENT CAMP

KICKING CAMP
COACHING THE COACHES

CLIENT INFORMATION (FOR SPECIALISTS & COACHES):

First Name:   

Last Name:     

E-mail:            

Address 1:      

Address 2:      

City:                

State:              

Zip Code:        

Phone:            

Cell Phone:     

School:            

CLIENT INFORMATION (FOR SPECIALISTS ONLY):

SPECIALIST'S POSITION (choose appropriate box/boxes):

Kicker Kickoff   Punter  Holder   Snapper

Height:            

Weight:           

Shirt Size:        L  XL XXL XXXL

College Class:

Freshman    Sophomore  Junior  Senior  Graduate

SPECIALIST'S COACH INFORMATION:

Name:           

E-mail:          

SPECIALIST'S AGENT INFORMATION:

Name:           

Phone:          

E-mail:          

ADDITIONAL COMMENTS:

Note any pertinent information you would like us to be aware of related to attending a Coach Zauner program . This might include any noteworthy stats or post-season awards in kicking, punting or long snapping you have received.

SPECIALIST'S PARENT/GUARDIAN INFORMATION:

Name:           

Phone:          

Email 1:        

Email 2:        

SPECIALIST'S HEALTH INFORMATION:

Insured By:    

Policy #:          

Do you have any physical restrictions, medical issues, allergies and/or medication requirements?

Yes  No

If yes, please describe in the box below:

TERMS AND CONDITIONS FOR ATTENDING ANY COACH ZAUNER, LLC PROGRAM:

* Program will be held regardless of inclement weather conditions.
* Program will be re-scheduled if cancelled due to extreme act of nature (Coach Zauner, LLC will offer no refunds).
* Program rules covered at first camp meeting.
* Discipline problems will not be tolerated.
* Offenders will be dismissed without a refund.
* Registrants will be liable for any damages they cause while attending a Coach Zauner, LLC Program.

If you are attending a Coach Zauner, LLC Program, you understand and agree to these conditions ('Yes' must be checked by all registrants wishing to participate in any Coach Zauner, LLC Program):

Yes  No

HOLD HARMLESS AGREEMENT:

By completing and submitting this registration you are in agreement and accept the terms of the Coach Zauner, LLC Hold Harmless Agreement ('Yes' must be checked by all registrants wishing to participate in any Coach Zauner, LLC Program):

Yes   No

CLIENT INFORMATION (FOR SPECIALISTS & COACHES):

PAYMENT INFORMATION (check program details for payment requirement):

Check   Credit Card (Visa/MasterCard accepted and subject to 3% processing fee)

Make Check Payable To: Coach Zauner, LLC

Mail Check To:

Coach Zauner, LLC
15132 E. Cholla Crest Trail
Fountain Hills, AZ 85268

Call With Credit Card Information:

Michelle Zauner
480.816.1297

MEDIA RELEASE:

By completing and submitting this registration you are in agreement and accept the terms of the Coach Zauner, LLC Media Release.

Yes  No

CONFIRMATION:

Please enter your name in full to signify the above information is correct and you agree to the Coach Zauner, LLC Terms and Conditions set forth ('Box' must be filled in by all registrants wishing to participate in any Coach Zauner, LLC program):

Name: