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Cougar Track Club, Inc

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Online Registration Form

* SELECT THE TRACK LEAGUE YOUR CHILD WILL PARTICIPATE IN.:

COUGAR MEMBER INFORMATION

* First Name:

* Last Name:

Street:

City:

State:

Zip Code:

Home Phone:

Birthdate:

Email:

Gender:

Grade:

* COUGAR SPEED SUIT SIZE:

In everyday wear, does your child wear Youth sizes(youth sizes are small, normally use for younger kids)

X-Small

Small

Medium

Large

In everyday wear, does your child wear Adult sizes

Small

Medium

Large

X-Large

COUGAR PARENT/GUARDIAN #1

Firstname:

Lastname:

EMail:

Home Phone:

Work Phone:

Cell Phone:

COUGAR PARENT/GUARDIAN #2

Firstname:

Lastname:

Email:

Home Phone:

Work Phone:

Cell Phone:

MEDICAL/EMERGENCY CONTACT INFORMATION

Emergency Contact:

Phone:

Relationship to Track Club Member:

I understand that my child will not be covered by insurance for any non-sanctioned USATF or AAU events and that I may have my own insurance policy, or if not, I wil cover the expenses of any injury

Insurance Carrier:

Policy #:

I grant permission to managing personnel or any track authority to authorize and obtain medical care from any licensed physician, hospital, or medical clinic should the participant become ill or injured while participating in track activities. *

I also grant permission at other times when neither parent/guardian is available to grant authorization for emergency treatment. *

PARENTAL RELEASE FOR INTERVIEWING, PHOTOGRAPHING, AND VIDEO-RECORDING OF ATHLETE.

On occasion the Cougar Track Club athletes may be photographed, interviewed and/or videotaped. Doing so is solely for promotion materials, advertisements, presentations, programs and Internet sites. Your athlete's name may also be used in conjunction with or by any medium, including print, electronic, radio and television. I authorize the organizers and professional staff, to use pictures taken of the above named participants, in future track related activities literature and presentations at State and National Conferences.

I grant permission to the Cougar Track Club, or anyone properly authorized in the organization to interview, photograph, audio-record and/or videotape my athlete during track activities. *

I the parent/guardian of child listed above do hereby attest that my child's "physical form" currently on file will expire during the middle of the Cougar Track Club season, which competing season will officially end the first week of August. If requested,a new physical form will be provided. My failure to provide a new physical form will receive the Cougar Track Club of any liability.

PARENTAL AUTHORIZATION: I, parent or guardian of the above named child hereby gives approval to his/her participation in practices, track meets, travel and other activities sanctioned, sponsored, and /or attended by the Cougar Track Club. I parent or guardian authorize the coaches or staff members to sign the standard athlete's release form when entering my child in any sanctioned events. I assume all risks and hazards incidental to such participation including transportation to and from the activities; and do hereby waive, release, absolve, indemnify and agree to hold harmless the Cougar Track Club staff, instructors, participants and persons transporting the participants to and from activities, for any claim arising out of an injury to the participants.

I/we agree with the above *

* indicates required fields

Cougar Track Club, Inc

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