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30 Minute Solution Appointment Form

First name (athlete) *

Last Name (athlete) *

Email *

Most ideal days to train *

Most ideal times to train *

Weight *

Tell me about yourself *

What issue are you looking to solve? *

Required Waiver: I agree to hold harmless Randy Simpson, staff, and property owners, from and against any injuries sustained by the participant. The understanding hereby releases, waives, and forever discharges Randy Simpson and Randy’s Attack System Wrestling, LLC, from and against any and all claims, injuries, demands, actions, or cause of actions arising out of the participation by the athlete in Randy’s Attack System Programs. I authorize the program director and/or staff to act in my behalf regarding any situation requiring discipline or medical attention. My son is physically fit to participate in this program, according to his family doctor. I understand that payment arrangement is due before attending sessions. *I agreeI completely agree

Injury Policy: We don't offer refunds for folks who just plain don't show up. However, If your athlete cannot attend due to a medical issue, and you inform me in a reasonable time, a CREDIT may be applied for future training. *I agreeI completely agree

Name of Parent/Guardian agreeing to the above *

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