Injury Prevention Program Registration :: Nationwide Children's Hospital

Injury Prevention Program Registration

To register for any of Nationwide Children's Sports Medicine Injury Prevention Programs, 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 within one business day 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) 355-6013.

Registration Form
Athlete's First and Last Name: *
Male/Female: *
Male
Female
Age: *
Grade Entering in Fall: *
School: *
T-shirt Size: *
Program(s) Registering for: *
Speed and Agility Program - All Sports (Feb 20 - March 28 - Westerville Sports Medicine Center)
ACL Bootcamp (April 16th - May 23rd - Westerville Sports Medicine Center)
Strength and Power Program (June 11th - July 19th - Westerville Sports Medicine Center)
Speed and Agility Program (June 12th - July19th - Dublin Sports Medicine Center)
Dance Injury Prevention Program (July 9th - July 25th - Dublin Sports Medicine Center)
Your Name: *
Your Relationship to Athlete: *
Street Address: *
City: *
Zip Code: *
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
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Other

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Nationwide Children's Hospital
700 Children's Drive Columbus, Ohio 43205 614.722.2000