Parmy's LLC
Registration Form
Fall 2017 Programs

Name: _________________________________________________
Address: _________________________________________________
  _________________________________________________
City, State & Zip: _________________________________________________
Age/Date of Birth: ________________________
Height/Weight: ________________________
Phone: ________________________
Email Address: ________________________
Emergency Contact & Phone: _________________________________________________
Current Team: _________________________________________________
Current Coach: _________________________________________________
Position: _________________________________________________



*** CIRCLE THE PROGRAM CODE OF THE SESSION OR SESSIONS THAT YOU WISH TO REGISTER FOR ***

Strength and Development Programs

10 Week Strength and Development Program - 2 Days a Week - Any Combination of 2 Days and Times
     Location: 145 Bodwell Street, Avon Massachusetts
     Duration: September 11th - November 16th
     Cost: - $500

     ** Circle the 2 Days and Times

Program Code Eligibility Days Times Notes
CFALL1 2004, 2003, High School,
Midget, Prep, Junior
Mondays 4:15pm - 5:15pm Starts September 11th
CFALL2 2004, 2003, High School,
Midget, Prep, Junior
Mondays 7:15pm - 8:15pm Starts September 11th
CFALL3 2004, 2003, High School,
Midget, Prep, Junior
Wednesdays 4:15pm - 5:15pm Starts September 13th
CFALL4 2004, 2003, High School,
Midget, Prep, Junior
Wednesdays 7:15pm - 8:15pm Starts September 13th
CFALL5 2004, 2003, High School,
Midget, Prep, Junior
Thursdays 4:15pm - 5:15pm Starts September 14th
CFALL6 2004, 2003, High School,
Midget, Prep, Junior
Thursdays 7:15pm - 8:15pm Starts September 14th



Shooting Programs

10 Week Private Shooting Program - 2 Players per session
     Location: 145 Bodwell Street, Avon Massachusetts
     Cost: $500.00 per Player

     Note: Please contact Scott at 508-525-6747 regarding availability of a time slot prior to registering.
     No spots will be reserved without a deposit.

Program Code Eligibility Days Times Notes
CFALL7 Closed Sundays 8:00am - 9:00am Starts September 17th
CFALL8 Closed Sundays 9:00am - 10:00am Starts September 17th
CFALL9 Closed Sundays 10:00am - 11:00am Starts September 17th
CFALL10 Closed Sundays 11:00am - 12:00pm Starts September 17th
         
CFALL11 Closed Mondays 5:15pm - 6:15pm Starts September 11th
CFALL12 Closed Mondays 6:15pm - 7:15pm Starts September 11th
CFALL13 Closed Mondays 8:15pm - 9:15pm Starts September 11th
         
CFALL14 Closed Wednesdays 5:15pm - 6:15pm Starts September 13th
CFALL15 Closed Wednesdays 6:15pm - 7:15pm Starts September 13th
CFALL16 Closed Wednesdays 8:15pm - 9:15pm Starts September 13th
         
CFALL18 Closed Thursdays 5:15pm - 6:15pm Starts September 14th
CFALL19 Closed Thursdays 6:15pm - 7:15pm Starts September 14th
CFALL20 Closed Thursdays 8:15pm - 9:15pm Starts September 14th



Parmy's LLC Waiver: I hereby certify that the above-named Applicant is covered by a certified health insurance plan either through his/her parent, guardian or employer. I further certify that after consultation with the Applicant’s health care provider I have determined that the Applicant is sufficiently fit and healthy to participate in a vigorous physical exercise and training program.

I acknowledge that Parmy’s, LLC and its staff will have made no independent determination of the fitness of the Applicant for the program, and that Parmy’s and its staff shall be held harmless and shall not be responsible or liable for any injury suffered by the Applicant as a result of participation in the program. I am aware of the risks of participating in a vigorous physical exercise and training program and hereby waive and release all claims I or the Applicant may have relating to injuries incurred as a result of participating in the program. I also confirm that the Applicant is in excellent health and is able to participate in a vigorous physical training program. Parmy’s, LLC reserves the right to reject any Applicant if in its sole judgment such Applicant’s participation in the program would create an undue risk of injury to the Applicant or others, or if for any other reason it determines that the program is not appropriate for such Applicant.

Applicant or Parent/Guardian Signature _______________________________________ Date _________________

Print Name Signed Above _______________________________________

Deposit:
We require a 50% non-refundable deposit with the registration form. The balance is due at the first session. Applications are taken on a first come, first serve basis. There will not be a refund to the player if he/she leaves a session on their own, misses a session, or is expelled from a session.

Make Checks Payable to: Parmy's, LLC

Mail check and registration form to:
   Scott Parmentier
   2 Mill Village Road
   Berkley, MA 02779