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Registration

Registration Form

Athlete's First Name *:

Please enter athelete's first name.

Athlete's Last Name *:

Please enter athlete's last name.

Athlete's Birth Date: *:

Athlete's Gender *:

Female

Male

Athlete Race Interest:

100m

200m

400m

800m

1600m

3200m

Hurdles

Jumps

Throws

Athlete's Class *:

Athlete's Current School *:

Please enter a valid school.

Email *:

Please enter a valid email address.

Secondary Email:

Please enter a valid name.

Parent's Name/Primary Contact Name*:

Please enter a valid name.

Primary Contact Number*:

Please enter a valid phone number.

Secondary Contact Name:

Please enter a valid name.

Secondary Contact Number:

Please enter a valid phone number.

Emergency Contact Name *:

Please enter a valid name.

Emergency Contact Number *:

Please enter a valid phone number.

Address *:

List any allergies, medications, adverse health conditions, etc. (list N/A if none) *:

Any additional information of which the Club should be aware:

Parent(s) interested in coaching/assisting? *:

Code:

Please enter a valid code.

Please choose your registrations:

$50 - 2019 Track Fee - Mandatory

Please check below to acknowledge that you have read the waiver.

I have read and understand the participation/media/medical waivers.*

Total:

$50