I understand I am completing an application to show interest in a Mental Performance Training Camp for High School Athletes in Jacksonville, Florida.

I understand

No, I do not understand

Athlete's Phone

(###)

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The Camp will include Mental Training in 3 environments: Athletic, Academic and Social. Athlete will be under pressure to see how they respond and our Coaches will be evaluating their performance. *

I understand

No, I do not understand

This is not a “showcase camp” where you run through drills with 100 athletes and no coaches talk to you the entire day. Our Camp is designed to give the Athlete more Confidence, More Focus so they can Perform better in their sport.

I understand

No I don’t understand

We encourage parents to mingle with other parents and share your journey. Parents can be in facility for Training but CANNOT ask questions of Coaches or communicate with their Athlete in gym.

1 Parent Attending

2 Parents Attending

We understand the Coaches don't want children or siblings in sports facility

My athlete has no health issues that would prevent them from an intense workout. I will sign a waiver to workout at D1 included in this 1 day camp.

I agree

I do not agree

I understand the Mental Performance Training Camp includes College Prep Coaches, Training, & Facilities. Camp DOES NOT provide Hotel, Travel or Food. *

Agree

Disagree

Most accurate description of current state of Athlete: *

Need help in Weight Room

Need help with Mental Game

Need Mechanics help

Need better Social Skills

Need More Confidence

Need More Leadership skills

My Athlete is Perfect

Check which statement(s) apply:

We want to play much better on this team

We want to get out of the current rut

We want to play Varsity Sports

We want to play College Sports

We want to play Professional Sports

If anything else, list in specific goals

Is your athlete currently involved with marijuana, vaping or any illegal drugs?

Yes

No

Possibly

Not sure

Managing Parent's Name

Main parent managing athlete. Coach J's parental contact

First Name

Last Name

Managing Parent's Phone

(###)

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Supportive Parent

Managing Parent's Spouse

First Name

Last Name

Supportive Parent Phone

(###)

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Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Payment Methods *

$100 deposit required to hold the spot or can be paid in full. 5-15 spots available, once full, camp is closed. It is refundable up to 14 days before event. Total $500

Venmo (send venmo friend request Coach Jay Holgate) @Jay-Holgate-1

Zelle (listed as Jay Holgate 404-597-4247)

Health Savings Account or (insurance debit card)

Credit card on file

Coach J Does Not Accept Insurance

I understand that there are limited spots for these camps. Facilities have been rented, Coaches contracted & commitments made to accommodate your athlete. If you do not make the payment deadlines, If you leave the camp early or quit, no money will be refunded. If your Athlete is disrespectful, we will give 1 warning & then they will be dismissed for unacceptable behavior or attitude.

I understand

I do not understand

After event, parents can have access to Coach J, I understand that every phone call with Coach J is billable time ($120/hr, $75 half hour). *

Agree

Disagree

I understand that Coach J cannot be held liable for any future actions by my child that result in injury, damages, financial and otherwise *

Agree

Disagree

I understand that this Camp does not discriminate to different categories of people, especially on the grounds of ethnicity, age, sex or disability.

I agree

I disagree

Who participated in completing this form?

Athlete

Dad

Mom

Step parent

Coach/Trainer

Agent

Corporate sponsor

Other

C If staying overnight, we recommend the Hyatt Place Hotel in St John’s Town Center 4742 Town Center Parkway, Jax Florida 32246.heckbox

Option 1

Option 2