One-Week Trial Registration

We offer a one-week trial membership for new members, free of charge. You must complete the registration below, before arriving to any practice session.

Program(Required)

Please use the dropdown below to select the program you would like to register for.

Athlete Information

Athlete Name(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Email(Required)

Primary Phone

Date of Birth(Required)

2022/23 School(Required)

2022/23 Grade Level(Required)

Parent Information

Parent 1(Required)

Email(Required)

Primary Phone(Required)

Secondary Phone

Additional Parent

Primary Phone

Secondary Phone

Athlete Health Insurance Information

Health Insurance Carrier Name(Required)

Health Insurance Policy Number(Required)

Liability Waiver

Terms and Risk Acceptance(Required)

I agree to the terms.

I, the undersigned, in full recognition and appreciation of the dangers and hazards inherent to the above mentioned programs or class, do hereby voluntarily agree to assume all associated risks and responsibilities to which I may be exposed during transportation to and from all activities or classes and during my participation in the activity or class. In addition, I intend to be financially responsible for any property damage / loss or injuries that may occur as a result of my negligence or failure to follow instructions. I have been provided verbal and /or written information that describes the activities and their inherent dangers, hazards, and possibilities of injury or damage (see third paragraph). In addition, I have been or will be provided with training to safely participate in each activity or segment of the activity. Further, I do, for myself, my heirs, successors, assigns, and personal representative(s), hereby agree to release Alaska Pacific University, itâs Board of Trustees, officers, agents, and employees from all liability, loss, damage and expense, including reasonable attorney fees, which may arise on account of damage to property or personal injury, death or emotional distress resulting from my transportation to and from or my participation in all activities or classes, provided the damage, injury, death or emotional distress does not result from the gross negligence or intentional misconduct of Alaska Pacific University, its Board of Trustees, their officers, agents, or employees. I enter into the exercise and fitness program offered at Alaska Pacific University voluntarily. I am aware that there are potential risks involved in traveling through the wilderness in Alaska. Some risk include, but are not limited to, encountering severe weather, avalanche, bear, moose, or other wild animals; falling a long distance in steep terrain; slipping on ice; pulled, sore and / or strained muscles; shin splints; and other various exercise related injuries; I also understand that when traveling in a University vehicle or any personal vehicle there is potential risk of being involved in a traffic accident. These hazards and risks may result in a head or spinal injury, paralysis, broken bones, separated joints, severe lacerations, frostbite or death. All participants are advised to properly dress for extreme weather conditions and be prepared for backcountry survival in the event of an emergency. I am in good health and have my physiciansâ approval to exercise. I will inform the instructor or coach of any changes in my health status. I hereby authorize APU to request on my behalf, should I be injured or require emergency treatment, medical assistance including ambulance, and agree to be responsible for all costs thereof. I have proof of health insurance that will cover any injury that I might sustain during this activity. I agree to give all user rights and privileges of any photographs, slides, negatives, or video of my image to Alaska Pacific University. I knowingly give permission to use images in any university advertising, public relations effort, curriculum design, or curriculum delivery.

Health Questions

Is the athlete in good health?(Required)

Yes

Does the athlete have their physician's approval to exercise?(Required)

Yes

Please indicate below if the athlete has one or more of the following conditions:

You can select more than one. On a Mac: Press and hold the Command key, then click the items. On Windows: Hold down the Ctrl key as you select multiple items.

Please list any other health related conditions the athlete may have:

Please list all prescription and / or over the counter drugs the athlete is presently taking:

Please list any medications the athlete is allergic to:

Emergency Contact

Name(Required)

Emergency Contact Primary Phone(Required)

Emergency Contact Secondary Phone(Required)

This field is for validation purposes and should be left unchanged.

One-Week Trial Registration

Athlete Information

Parent Information

Athlete Health Insurance Information

Liability Waiver

Health Questions

Emergency Contact

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