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Registration Form

Email Address *

Password *
(at least 6 characters)

Contact Information

Name *

First Last

Alternate Email Address(es)
(separate multiple by commas or semi-colons)

Phone Number

Address

City

State/Zip Code

State Zip Code

Member Information

Emergency Contact/Number

How did you hear about us?

Program

Program *

Details

• Name: JR RYPT - 1-Day (M-TH at 10:30) OR (M/W ONLY at 5:45)
• Restrictions: Middle School
• Schedule: Mon, Tue, Wed and Thu from Jun 24 to Aug 8, 2024
• Closed: Jul 4 for July 4th, N/A
• Price: $199.00

Location

RYPT
1540 West Park Avenue Suite 4
Tinton Falls, NJ 07712

Start Times

Weekdays *
10:30am
5:45pm

Athlete

Athlete's Name *

First Last

DOB *

Primary Sport *

Primary Position

School *

Athlete's Cell Phone *

Previous Injuries *

Medical Issues/Concerns *

Goals

Athlete's Email

T-shirt size *
(all sizes are adult male)

Current School Grade *
(e.g. 7th, 10th, etc.)

Payment

Amount

$199.00

Payment Plan
(payments are charged monthly on the same day as registration)

Promo Code

Payment Method

Visa MasterCard AmEx Discover

Name on Card *

First Last

Card Number *

Card Security Code *

Expiration Date *

Keep Credit Card on File
(payment plans require info to be saved on file for automatic monthly payments until the balance is paid in full)

No Yes

Billing Address same as contact

Address *

City *

State/Zip Code *

State Zip Code

Optional

Comments

Policies & Waivers

RYPT Waiver
Waiver and Release of Liability

Reach Your Potential Training, Inc. (â€œRYPTâ€)
Elite Sports Physical Therapy, Inc. (â€œESPTâ€)
(collectively hereinafter referred to as the â€œClubâ€, â€œWeâ€, or â€œOurâ€)

â€œYouâ€ or â€œYourâ€, as used herein, shall mean the individual participant and/or the guardian of the individual participant if he/she is a minor.

You acknowledge that physical activity, including sport and sport activity, can be strenuous and subject You to risk of serious injury.  You agree, on behalf of the individual participant and the participant's heirs and estate, that if you engage in any physical exercise or activity, or use any club amenity, on the Club's premises or off premises, including any sponsored Club event, you do so entirely at your own risk. Any recommendation for changes in diet including the use of food supplements, weight reduction and or body building enhancement products are entirely your responsibility and you should consult a physician prior to undergoing any dietary or food supplement changes. You agree that you are voluntarily participating in these activities and use of these facilities and premises and assume all risks of injury, illness, or death. We are also not responsible for any loss of your personal property.

This Waiver and Release of liability includes, without limitation, all injuries and/or property damage which may occur as a result of, (a) the individual participant's use of all Club premises and facility, including the improper maintenance thereof; (b) the individual participant's use of all amenities and equipment in the facility, including the improper maintenance thereof; (c) the individual participant's participation in any activity, class, program, personal training or instruction; (d) the sudden and unforeseen malfunctioning of any equipment; (e) the improper maintenance of any amenities or equipment; (f) Our instruction, training, supervision, or dietary recommendations; (g) the individual participant's slipping and/or falling while in the Club, or on the Club premises, including adjacent sidewalks and parking areas; (h) First Aid, emergency treatment or any other services rendered or failed to be rendered by the Club or its employees, emergency personnel or good Samaritans, or the Club preventing a good Samaritan from rendering first aid; (i) Our hiring or retention of any employee; (j) loss of consortium; and (k) the use of any photographs or video of the individual participant for purposes of promotion, advertising or public display.

You further acknowledge that the Club does not manufacture fitness or other equipment, but purchases and/or leases equipment from manufacturers or distributors.  You understand and acknowledge that the Club is providing recreational, sports performance, fitness, or health related services, and You will not hold the Club liable for an alleged defective product.

You acknowledge that you have carefully read this Waiver and Release and fully understand that it is a release of liability. You expressly agree to release and discharge the Club, and all affiliates, employees, agents, representatives, successors, or assigns, from any and all claims or causes of action, and you agree to voluntarily give up or waive any right that you may otherwise have to bring a legal action against the Club for personal injury or property damage.

To the extent that statute or case law does not prohibit releases for negligence, this release is also for negligence on the part of the Club, its agents, employees or anyone acting on its behalf.

If any portion of this release from liability shall be deemed by a Court of competent jurisdiction to be invalid, then the remainder of this Waiver and Release from liability shall remain in full force and effect and the offending provision or provisions severed here from.

You hereby consent to the photographing of the individual participant (including video photography) by the Club staff for purposes of advertising or public display. You also understand that the photography/video may be used for promotional purposes for RYPT or ESPT on the Internet, including but not limited to Facebook, Twitter, and Youtube.  

By signing this Waiver and Release, I acknowledge that I understand its content and that this release cannot be modified orally.


Billing on file
ALL registrations must be paid through our online payment processor, www.authorize.net. In order to do this, you must select UPDATE/KEEP CREDIT CARD ON FILE so that they system can automatically generate your invoices. Please be sure to select this option prior to submitting your registration.

If you are a new athlete, please sign up for a new athlete assessment HERE prior to finalizing your registration

Digital Signature:

Registration Form

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Contact Information

Member Information

Program

Athlete

Payment

Billing Address same as contact

Optional

Policies & Waivers