2020 TRAINING CAMP 1 REGISTRATION 1Location Information 2Account Registration3Participant Information 4Payment Information Locations: • Madison, MS - Madison Central High School football field and weight room (1417 Highland Colony Parkway, Madison, MS 39110) • Flowood, MS - University Wellness Center (2625 Courthouse Circle, Flowood, MS 39232) • Biloxi, MS - St. Patrick Catholic High School football field and weight room (18300 St. Patrick Road, Biloxi, MS 39532) • Pascagoula, MS - Pascagoula High School football field and weight room (1716 Tucker Avenue, Pascagoula, MS 39567) • Greenville, MS - The Hodding Carter Memorial YMCA (1688 Fairground Road, Greenville, MS 38703) Dates: Tuesday, January 14, 2020 - Friday, March 6, 2020 Training Days: Tuesday - Friday (4 days per week)Location: Madison Central High School football field and weight room (1417 Highland Colony Parkway, Madison, MS 39110) Dates: Tuesday, January 14, 2020 - Friday, March 6, 2020 Training Days: Tuesday - Friday (4 days per week)Location: University Wellness Center (2625 Courthouse Circle, Flowood, MS 39232) Dates: Tuesday, January 14, 2020 - Friday, March 6, 2020 Training Days: Tuesday - Friday (4 days per week)Location: St. Patrick Catholic High School football field and weight room (18300 St. Patrick Road, Biloxi, MS 39532) Dates: Tuesday, January 14, 2020 - Friday, March 6, 2020 Training Days: Tuesday - Friday (4 days per week)Location: Pascagoula High School football field and weight room (1716 Tucker Avenue, Pascagoula, MS 39567) Dates: Tuesday, January 14, 2020 - Friday, March 6, 2020 Training Days: Tuesday - Friday (4 days per week)Location: The Hodding Carter Memorial YMCA (1688 Fairground Road, Greenville, MS 38703) Dates: Tuesday, January 14, 2020 - Friday, March 6, 2020 Training Days: Tuesday - Friday (4 days per week)Cost: $470.00Early Bird Special Pricing: $370.00 The early bird special pricing ends Friday, January 3, 2020 at 11:59 p.m. Paul Lacoste Sports, Inc. must have registration, waiver, and full payment on or before Friday, January 3, 2020 at 11:59 p.m. in order for an individual to receive the early bird discount.Training Location* Madison, MS - Madison Central High School football field and weight room (1417 Highland Colony Parkway, Madison, MS 39110) Flowood, MS - University Wellness Center (2625 Courthouse Circle, Flowood, MS 39232) Biloxi, MS - St. Patrick Catholic High School football field and weight room (18300 St. Patrick Road, Biloxi, MS 39532) Pascagoula, MS - Pascagoula High School football field and weight room (1716 Tucker Avenue, Pascagoula, MS 39567) Greenville, MS - The Hodding Center Memorial YMCA (1688 Fairground Rd., Greenville, MS 38703) HiddenLocation ID HiddenSession ID HiddenTraining ID Schedule Selection* Session 1: 5:00 a.m. - 6:00 a.m. Session 2: 6:00 a.m. - 7:00 a.m. Are you an employee of Margaritaville Resort Biloxi, Centennial Plaza, or White House Hotel/Cora's Restaurant?* Yes No Account RegistrationEmail*Your email will be your username. Enter Email Confirm Email Password* Enter Password Confirm Password Participant InformationName* First Last Cell Phone*Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Birthday* MM slash DD slash YYYY Age*Please enter a number from 0 to 100.Gender*MFT-Shirt Size*SMLXL2XL3XL4XLEmergency Contact InformationEmergency Contact Name* First Last Emergency Contact Relation* Emergency Contact Cell Phone*Health InformationCurrent Health Rating*Choose OneNo Health IssuesMinor Health IssuesModerate Health IssuesMajor Health IssuesCurrent Fitness Rating*Choose OneExtremely FitVery FitModerately FitUnfitMedical / Surgical History*Performance / Fitness Goals*Waiver Waiver & Release of Liability In consideration for the rights and privileges associated with my "participation in athletic strength and agility training by Paul Lacoste Sports, Inc." I acknowledge and agree to be bound by the following: Physical Ability. I understand that I will be participating in athletic strength and agility training under the guidance of Paul Lacoste Sports, Inc. I declare that I have been examined by a licensed medical physician prior to my participation in the Activity and I am aware of no physical limitations or adverse health risks associated with my participation in the Activity other than that shown in the space below. I also declare that if I later become aware of any physical limitation or adverse health risks associated with my participation in the Activity, I will immediately cease participation and notify Paul Lacoste Sports, Inc. of said condition. Assumption of the Risks. I agree that I am responsible for my safety while participating in the Activity and that such responsibility includes participating in the Activity only when I am both physically and psychologically prepared to participate safely. I ASSUME ALL RISKS CONNECTED WITH RESPONSIBILITY FOR ANY INJURY OR LOSS CONNECTED WITH MY PARTICIPATION IN THE ACTIVITY. Waiver. Aware of the risks and willing to assume them, I hereby WAIVE, RELEASE, AND HOLD HARMLESS Paul Lacoste Sports, Inc. and each of this organization\'s members, employees, agents, coaches, trainers, volunteers, doctors, event organizers or sponsors, if any ("Releasees") from all claims by me for any liability, injury, loss or damage in any way connected with my participation in the Activity, except where caused by the gross negligence or willful or wanton misconduct of any of the Releasees. I intend for this Waiver and Release to also apply to any spouse, relatives, personal representatives, heirs, beneficiaries, next of kin or assigns who might pursue any legal action or claim on my behalf. Insurance. I understand that it is my sole responsibility to maintain adequate medical insurance and understand that Paul Lacoste Sports, Inc. is not responsible for and will not be providing this coverage for me. Acknowledgement of Risks. I understand that participation in any athletic activity or other vigorous exercise, including but not limited to preparation for and participating in athletic strength and agility training ("the Activity"), involves risks of serious injury, including permanent disability, death, and other losses, both to me and my property. I understand that these injuries and losses might result not only from my actions, but from the actions, inactions or negligence of others. Use of Photographs and/or Videos Containing My Likeness. I understand that throughout my participation in the Activity, photographs and/or videos will be taken which may include myself engaging in the performance of the Activity. I hereby authorize any such photograph(s) and/or video(s) to be used by Paul Lacoste Sports, Inc. for any lawful purpose including, but not limited to, marketing, sales and merchandising. Acknowledgement of Limited Space. I understand and acknowledge that each event conducted by Paul Lacoste Sports, Inc. is limited to a specific number of participants in order to enhance each participant\'s overall experience. By signing up for this event I am occupying a space that could have been sold to another participant. I am therefore committed to paying for my space in full regardless of whether or not I complete the training. No circumstance, including but not limited to, injury, fatigue, and/or scheduling conflicts, will release me from my commitment to pay for my space. Payment for my space is non-refundable and my space is non-transferable. PHYSICAL LIMITATIONS OR ADVERSE HEALTH RISKSAcceptance of Waiver & Release of Liability* By checking this "Accept" box, I am indicating that I understand the above terms and conditions and that I intend to be fully bound by the terms stated therein. Parent InformationParent Name* First Last Parent Email* Enter Email Confirm Email Parent Cell Phone*Parent Home PhoneParent Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Waiver & Release of Liability In consideration for the rights and privileges associated with my "participation in athletic strength and agility training by Paul Lacoste Sports, Inc." I acknowledge and agree to be bound by the following: Physical Ability. I understand that I will be participating in athletic strength and agility training under the guidance of Paul Lacoste Sports, Inc. I declare that I have been examined by a licensed medical physician prior to my participation in the Activity and I am aware of no physical limitations or adverse health risks associated with my participation in the Activity other than that shown in the space below. I also declare that if I later become aware of any physical limitation or adverse health risks associated with my participation in the Activity, I will immediately cease participation and notify Paul Lacoste Sports, Inc. of said condition. Assumption of the Risks. I agree that I am responsible for my safety while participating in the Activity and that such responsibility includes participating in the Activity only when I am both physically and psychologically prepared to participate safely. I ASSUME ALL RISKS CONNECTED WITH RESPONSIBILITY FOR ANY INJURY OR LOSS CONNECTED WITH MY PARTICIPATION IN THE ACTIVITY. Waiver. Aware of the risks and willing to assume them, I hereby WAIVE, RELEASE, AND HOLD HARMLESS Paul Lacoste Sports, Inc. and each of this organization\'s members, employees, agents, coaches, trainers, volunteers, doctors, event organizers or sponsors, if any ("Releasees") from all claims by me for any liability, injury, loss or damage in any way connected with my participation in the Activity, except where caused by the gross negligence or willful or wanton misconduct of any of the Releasees. I intend for this Waiver and Release to also apply to any spouse, relatives, personal representatives, heirs, beneficiaries, next of kin or assigns who might pursue any legal action or claim on my behalf. Insurance. I understand that it is my sole responsibility to maintain adequate medical insurance and understand that Paul Lacoste Sports, Inc. is not responsible for and will not be providing this coverage for me. Acknowledgement of Risks. I understand that participation in any athletic activity or other vigorous exercise, including but not limited to preparation for and participating in athletic strength and agility training ("the Activity"), involves risks of serious injury, including permanent disability, death, and other losses, both to me and my property. I understand that these injuries and losses might result not only from my actions, but from the actions, inactions or negligence of others. Use of Photographs and/or Videos Containing My Likeness. I understand that throughout my participation in the Activity, photographs and/or videos will be taken which may include myself engaging in the performance of the Activity. I hereby authorize any such photograph(s) and/or video(s) to be used by Paul Lacoste Sports, Inc. for any lawful purpose including, but not limited to, marketing, sales and merchandising. Acknowledgement of Limited Space. I understand and acknowledge that each event conducted by Paul Lacoste Sports, Inc. is limited to a specific number of participants in order to enhance each participant\'s overall experience. By signing up for this event I am occupying a space that could have been sold to another participant. I am therefore committed to paying for my space in full regardless of whether or not I complete the training. No circumstance, including but not limited to, injury, fatigue, and/or scheduling conflicts, will release me from my commitment to pay for my space. Payment for my space is non-refundable and my space is non-transferable. PHYSICAL LIMITATIONS OR ADVERSE HEALTH RISKSAcceptance of Waiver & Release of Liability* By checking this "Accept" box, I am indicating that I understand the above terms and conditions and that I intend to be fully bound by the terms stated therein. By clicking "Accept" I also certify that I am the Parent/Guardian of the. CAPTCHA Payment OptionsEarly Bird Payment Options* One payment of $370 Two payments of $185 each You can choose to pay all at once or in two easy payments! Payment Options* One payment of $470 Two payments of $235 each You can choose to pay all at once or in three easy payments! Payment DetailsProduct NameTraining Cost $0.00 Credit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20242025202620272028202920302031203220332034203520362037203820392040204120422043 Expiration Date Security Code Cardholder Name Useful Links About Programs Results Motivational Speaking Victory Sports Foundation Shop Contact (601) 398-0950 Paul Lacoste Sports Post Office Box 1998 Ridgeland, MS 39158 Follow Login