Running for Christ Track and Field

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PLAYER INFORMATION

* First Name:

* Last Name:

Street:

City:

State:

Zip Code:

Home Phone:

Birthdate:

Email:

Gender:

Grade:

PARENT/GUARDIAN #1

Firstname:

Lastname:

EMail:

Home Phone:

Work Phone:

Cell Phone:

PARENT/GUARDIAN #2

Firstname:

Lastname:

Email:

Home Phone:

Work Phone:

Cell Phone:

MEDICAL/EMERGENCY CONTACT INFORMATION

Emergency Contact:

Phone:

Relationship to Player:

Insurance Carrier:

Policy #:

WAIVER INFORMATION

I release, waive, and further agree to indemnify, hold harmless or reimburse The R.F.C Track Club, R.F.C Head Coach, R.F.C Coaches, R.F.C Staff, and R.F.C assigned Chaperone/Volunteers, from and against, any claim which I, any other parent or guardian, any sibling, the athlete, or any other person, firm or corporation may have or claim to have, known or unknown, directly or indirectly, from any losses, damages or injuries arising out of, during, or in connection with the athlete’s participation in the activity, any trip associated with the activity, or the rendering or emergency medical procedures or treatment, if any.

I/we agree with the above *

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