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CYA XC Sign Up Here
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Athlete Name:
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Address:
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City, State & Zip:
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Birthdate, Age, Gender:
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Mother's Name, Phone:
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Father's Name, Phone:
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Contact Email Address:
No Registration Fee
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Uniform Size Top Only. Please specify as YS, YM, YL, etc. Do not specify as "Size 10-12....Size 14-16...etc." I do not know what those sizes are.:
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Insurance Carrier & Policy Number:
Release of Liability:
In consideration of my child into this program, known as the Catoctin Youth Association Cross Country Program (CYAXC), 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 their 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 his or her name, picture or both 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.
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Parents Signature:
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Date:
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