GREECE TRACK CLUB

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2019 Athlete Registration Form

ATHLETE 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

In order for my self or child to participate in Track & Field as a member of the Greece Track Club for the 2019 season. I agree not to hold any volunteer or member of the Greece Track Club liable if the above-mentioned Participant is injured while participating in any Greece Track Club activity.

By checking the box below, and of my free will, I do hereby agree to indemnify and save harmless any volunteer or member of the Greece Track Club, Greece Central School District & The Town of Greece from any and all claims or demands, cost or expense arising out of any injuries or damage sustained by any party I am responsible to or for, including the above mentioned Participant.

I/we agree with the above *

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2019 Athlete Registration Form