Season Registration Form

2018-2019 Indoor Season

Athlete *
Athlete's Name *
Date of Birth: *
 /  / 
Age child will be this year: *
Gender: *
For new athletes, a birth certificate copy must be provided. Upload here.
Address: *
T-shirt size: *
Parent/Guardian Name: *
Relationship: *
Address of Parent/Guardian: *
Parent's Address (if different):
Parent/Guardian Phone Number: *
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Parent/Guardian E-mail: *
Emergency Contact Name: *
Emergency Contact Phone Number: *
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Emergency Contact Relationship: *
I hereby give my permission for any and all medical attention necessary to be administered to my child (named above) in the event of an accident, injury, sickness, etc., under the direction of the program officials and the person (s) listed below, until such time as I can be contacted. This release is effective until December 31, 2018. *
Physician Name: *
Physician Phone Number: *
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Allergies: *
I recognize that in any athletic activity there is an inherent risk of injury. As parent/guardian, I assume full responsibility for the safety of my child and agree to hold harmless the Plainfield Tsunami Track Club, its officers and coaches for injury sustained by child during and meet, practice, or track activity. *
Signature: *
Date: *
Volunteer Opportunities: *

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