Mark Mirabelli Track & Field Clinic LLC
Clinic Application

I wish to enroll my son/daughter in the 2020 Team Mirabelli Track & Field “Learn by Doing" Clinic. I understand that neither Toms River School District, John Bennett Indoor Athletic Center on 1519 Hooper Ave., Toms River NJ 08753 the director, nor anyone connected with the Mark Mirabelli Clinic will assume any responsibility for accidents, medical, dental or other expenses incurred as result of accidents sustained during or as a result of any course of instruction given the applicant by the clinic staff. I hereby authorize the guardian, coach, director to act on my behalf according to his/her best judgment in any emergency requiring medical attention.

Applicant's Name (required)

Email (required)

School (required)

Age (required)

Gender (required)
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Address (required)

City (required)

State (required)

Zip Code (required)

Phone (required)

Event (required)

Grade (required)

Parent/Guardian Signature (required)

Please SUBMIT this application form before continuing to payment. A confirmation email with this information will be sent to the email provided in the form.