Atlanta LAX Club Registration

Fall 2019 Registration

Please complete the online registration form below. Once you submit your registration, you will be directed to the online payment page. A spot is not guaranteed until payment is received and is successfully processed.

Fees: $180 - Please pay by Venmo, Check or Credit Card

Refunds are available minus a processing fee of $50. After Aug 15, no refunds available.

* Indicates required field

Parental Release: We (I) hereby request that you accept the application of my child in Balocki Athletics, LLC (DBA Atlanta LAX Club) during the dates set forth in this application. In consideration of your acceptance of the application, we (I) hereby release Balocki Athletics, LLC (DBA Atlanta LAX Club) and Trinity School and all their employees for any claims and liability of any nature on account of any injuries which may be sustained by our (my) child while attending The Atlanta LAX Club. We (I) agree to release from liability, hold harmless and indemnify the Atlanta LAX Club, and their employees for any claim which may hereafter be presented by our (my) child as a result of any such injuries. Furthermore, we (I) certify that, within the past year my child has had a physical examination and is physically able to participate in sports activities. In the event of illness or injury, we (I) give consent for medical treatment and permission to the attending physician to hospitalize, secure proper treatment, and order injection, anesthesia, or surgery necessary to render or obtain emergency medical treatment in our (my) children's best interest. Primary insurance is that of the family and SECONDARY insurance is that of the Balocki Athletics, LLC. *

I agree to the above I do not agree

Please Complete All Fields

Child's Name *

First

Last

Age *

Gender *

Girl Boy

Current Grade *

Parent Name *

Address, City, State, Zip *

Email *

School *

Phone *

Volunteer Coaches/Helpers Needed. If you'd be willing to lend your coaching skills or help otherwise, please check the box. *

Yes I'm interested in volunteering

Payment (after submitting registration, you will be taken to the payment page) *

Venmo or Check Credit Card

Submit Registration

After submitting registration, you will be taken to payment page.