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Velocity Acceleration Program
Name: ______________________________________ Grade: ________ Cell #: ____________T-Shirt S M L XL (circle)
Address: ____________________________________ City: ____________________ Zip: __________________
Students’ Email address: ______________________________________________ Home #: ___________________
Father/Guardian Name: _________________________________________ Cell #: __________________________
Email : ________________________________________ Work #: ________________________
Mother/Guardian Name:____________________________________________ Cell #:_______________________
Email address: __________________________________________________ Home # : ______________________
Health &Emergency contact information: ________________________________________________________________
__________________________________________________________________________________________________.
__________________________________________________________________________________________________
2015 Program will have 4 different programs to start June 1st to August 7th based on 2015-2016 Grades
_____ Option 1: ONLY Grades 5th-6th which will be 2 days a week Tuesday and Thursday 60 minutes for $120 if paid by April 14th
otherwise it is $140 or until sessions are full.
_____ Option 2 Grades 7 & up will be 3 days a week Monday, Wednesday, & Friday with 45 minutes of lifting and 45 minutes of
acceleration. This is what was offered in the past for $180 if paid for by April 14th otherwise it is $200 or until sessions are full.
_____ Option 3: Grades 7 and up will be 5 days a week program with sports specific drills geared to football, basketball, and
volleyball. For boys the program will consist of 60 minutes of lifting 3 days a week and 2 days Tuesday and Thursday of speed, agility,
& acceleration specific drills for 90 minutes. Girls would do 3 days of acceleration and 2 days of lifting. This program will cost $220 if
signed up by April 14th otherwise it will be $240 or until sessions are full.
_____ Option 4: Nutritional Program – This program is open to all with guidelines that will be an add-on for the 1-3 Acceleration
options which included in the program to meet specific athlete goals whether it's to gain muscle mass or become leaner. The cost of
this program is an additional $40 paid by April 4th and $50 after April 14th.
Make checks payable to: HANSON SCHOOL – checks will NOT be cashed until May 1st, NO CASH PAYMENT WILL BE ACCEPTED
You can follow the Velocity Acceleration program on Facebook by liking us Velocity Acceleration or on Twitter at VIP Accel.
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------Permission and Release:
Parent/Guardian Signature: _________________________________ release Velocity Program, Joe Monize, Hanson School, and any
other coaches/staff from claims on any injuries or accidents, which may be sustained by (athlete’s name)
___________________________________ while participating or resulting from the Acceleration Program.
Parent/Guardian Signature: ________________________________
Questions: Call Joe Monize (707)-494-2061 or [email protected] or Doni Bridge at 530-5277 or [email protected]
Paid: yes or no
Check# _________
Return the form to the HS Office
Amount ______
Initial Received by ________ NO CASH PAYMENT WILL BE ACCEPTED