THT Summer 2019 Application
Please complete the form below to apply for our 2019 Total Hockey Training program! We will reply as soon as possible with more information. Thank you!

Learn more HERE:

Email address *
Name *
Your answer
Cell *
Your answer
Age *
Your answer
Next Year's Team/ Level *
Your answer
THT Program of Choice *
Weekly Option *
Position *
Your answer
Personal Goals *
Your answer
List all Injuries, Health Conditions and/or Restrictions that may affect training *
Your answer
Are you interested in On-Ice Training as well? *
Shirt Size *
Liability Waiver (MUST BE 18 TO COMPLETE): I, being 18 years of age or older, do for myself (and for or on behalf of my child participant, if said child is not of age or older) do hereby release, forever discharge and agree to hold harmless Next Level Strength & Conditioning, LLC, Nathan J. VanKouwenberg, or any other owners, subcontracted trainers, or employees of Next Level Strength & Conditioning, LLC, while participating in supervised, or independent fitness training at the Next Level Strength and Conditioning training facility at in Fairport, NY, or at any other location, from any and all liability, claims or demands for personal injury, sickness or death, as well as property damages and expenses, of any nature whatsoever which may be incurred by the undersigned and/or the child participant that occur while said participant is participating in the above described activities. I (and/or the child participant) am aware that Nathan J. VanKouwenberg and other Next Level employees are not licensed physical therapists or trained medical personnel and am participating in this program voluntarily at my own risk and for recreational purposes only. I acknowledge that fitness training may be strenuous and that a physician’s examination and approval should be obtained prior to beginning any fitness program. I understand that it is my responsibility to notify Next Level staff of all restrictions and dates of release provided by Doctors and/or Physical Therapists. I accept all responsibility for my (and/or the child participant’s) health and any resultant injury that may occur during any Next Level Strength and Conditioning training session and agree to hold harmless and indemnify Next Level Strength & Conditioning, LLC, including owners, and any other Next Level employee or sub-contracted trainer. I understand that Next Level Strength & Conditioning, LLC are not responsible for supervision outside of set training times. I (and/or the child participant) also give Next Level Strength and Conditioning permission to take and post pictures and videos of me (and/or the child participant) participating in fitness activities for marketing purposes only. *
A copy of your responses will be emailed to the address you provided.
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