CYA Track & Field

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* Athlete Name:

* Address:

* City, State & Zip:

* Birthdate, Age, Gender:

* Mother's Name, Primary Phone:

* Father's Name, Primary Phone:

* Contact Email:

* Uniform Size: Top Only (Specify Top Size):

* Insurance Carrier & Policy Number:

Note About Uniforms:

Uniforms: Please be certain that you list your child's uniform as "AS", "AM", "AL", "YS", "YM", "YL", "YXL", etc. Do not list as "Size 12" or "Size 16", etc. Also, uniform order sizes are final. Be sure of your size.

Release of Liability:

In consideration of my child into this program, known as the Catoctin Youth Association Track & Field (CYATF), I intending to be legally bound, do hereby, for my child, executors, and administrators, waive release and forever discharge any and all rights for claims and damages, including any claims for loss, damages or injury to my child or property arising out of my child's performance or failure of performance from the Catoctin Youth Association, Catoctin High School, their agents, representatives, successors and assigns.

I certify that to the best of my knowledge and belief, my child is in good physical condition and has no disease or injury that would impair performance in competition. I, the undersigned declare on my honor that my child is of amateur status, and I also give permission for the use of my child’s name and/or picture to appear in any documentary, sponsor advertisement, newspaper, or other accounts relating to this program.

NOTE:

Your child must be covered under the insurance information provided above for him/her to participate in any activities associated with the Catoctin Youth Association Program.

In addition, a current copy of your child’s birth certificate must be provided prior to participation in any practices, meets, or activities.

Payment is due at time of registration - please pay below.

* Parents Signature:

* Date:

* indicates required fields

Payment Processing ($3.5) *