Premier Athletics of Nebraska
         Comprehensive Sports Training


On Line Registration Form

Please fill out this form, print and mail to:
Premier Athletics - Nebraska
P.O. Box 561
Elkhorn, NE 68022

CHOOSE PROGRAM (*Required Information)

Individual Training
Group Training
Shooting and Scoring Program
Ongoing Training
Shooting Clinics
Training Camps

Athlete's First and Last Name*

Age*  Grade*

Address*

City* State* ZIP*

Home Phone (include area code)*

E-mail Address:

Emergency Contact*

Emergency Phone (include area code)*

PAYMENT OPTIONS       Mail Payment        Bring Payment to Event

WAIVER OF LIABILITY
I authorize Premier Athletics of Nebraska to act as my agents in the event of a medical emergency. I acknowledge that the participation in athletic events involves the risk of physical injury, and as such, I hereby hold harmless and release Premier Athletics of Nebraska, its agents and employees from any demand, action or cause of claim arising out of our participation in any Premier Athletics event.
I agree