top of page

MISSION
PERFORMANCE

Disclosure and Consent Form

Purpose of Services

Mission Performance provides educational mental performance services for athletes, coaches, teams, and performers. These services are designed to teach skills that may support performance, confidence, focus, leadership, communication, resilience, preparation, and personal growth.

Participant Information

First name

Last name

Email

Phone

Birthday

Month

Day

Year

Address

Emergency Contact (Name and Phone Number)

Signatures

Participant Signature

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.

Printed Name

Date

Month

Day

Year

Parent/Guardian Signature (if participant is under 18)

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.

Printed Name

Relationship to Participant

Date

Month

Day

Year

bottom of page