Performance & Prevention Program Registration :: Nationwide Children's Hospital

Performance & Prevention Program Registration

To register for a Performance & Prevention Program, please complete the following two steps:

  1. Complete and submit our online registration form below. After submitting, a Nationwide Children's Sports Medicine Team member will contact you to confirm your registration.
  2. Download our release form here. You must bring a signed copy of this form to your first session to be able to participate.

If you have any additional questions, please call (614) 355-6057.

Performance & Prevention Program Registration Form
Athlete/Patient Information
Athlete's First Name: *
Athlete's Last Name *
Male/Female: *
Male
Female
Age: *
Street Address: *
City: *
State: *
Zip Code: *
Grade Entering in Fall: *
School Name: *
T-shirt Size: *
Program(s) Registering for: *
June 9th – July 24th Westerville Sports Medicine Center
June 10th – July 24th Dublin Sports Medicine Center
Parent/Guardian Information
First Name: *
Last Name: *
Your Relationship to Athlete: *
Phone (ex. 888 8888888): *
E-mail Address: *
How did you hear about us? (check all that apply)
Athletic Director
Athletic Trainer
Coach
Physician
Nurse
Parent
Friend
Advertisement
Other
Nationwide Children's Hospital
700 Children's Drive Columbus, Ohio 43205 614.722.2000