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Fast Lane Track Club

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Athlete Registration Form

* Athlete's Last Name:

* Athlete's First Name:

* Date of Birth:

* Gender:

Athlete Email Address (If applicable):

Athlete Cell# (if applicable):

* Parent 1/Guardian Name:

Home Phone #:

* Parent 1 Cell #:

* Parent 1 Email Address:

Parent 2/Guardian Name:

Parent 2 Cell #:

Parent 2 Email Address:

Emergeny Contact's Name (If Other than Parents/Guardian):

Relationship to Athlete:

Emergency Contact's Phone #:

* Athlete's Physician's Name:

* Physician's Phone #:

* School Athlete Attends:

Consent and Release Forms

I hereby give my consent for the above named child to participate in practices, track and field events, travel and other activities sanctioned, sponsored and/or attended by the Fast Lane Track Club and the USATF/AAU. I hereby indemnify and hold harmless the Fast Lane Track Club, Board of Directors, Head Coaches, Staff, Volunteers and Chaperones against any and all rights and claims which I have or which may arise in conjunction with my and my child's participation or travel to and from practices, track and field events and/or other activities sanctioned, sponsored and/or attended by the Fast Lane Track and the USATF/AAU. I also agree to abide by the rules of the Fast Lane Track Club and understand that all fees are non-refundable.

I agree to the above statement *

Medical Information / Waiver / Consent & Release For Emergency Treatment

Please list any health problems or preexisting conditions that may limit your child's training or activity level:

Please list any allergies your child has and any medications that he/she is taking:

I hereby authorize a club representative of Fast Lane Track Club to seek and sign for medical treatment for my child, a member of said club, in an emergency situation. I also authorize that the same representative be allowed to sign for medical treatment in non-emergency situations wwhen my child is traveling with the club or when I am unable to be reached by phone. I also understand that I am responsible for all costs associated with the treatment of my child. I also agree for myself, my heirs and personal representatives to waive and release all claims for damages I may now or herafter have arising out of the above named person's participation in any activities of Fast Lane Track Club. I further state that to my knowledge, the applicant has no health problems or preexisting conditions, not previously mentioned that limit his/her training or activity level.

I agree to the above statement *

Athlete Photo/Media Release

The Fast Lane Track Club has my permission to take and use my child's photographs, digital images and video images for official club purposes such as, but not limited to media press releases, postings on our webiste, newsletters, flyers, brochures, social media, etc.

I agree and give my consent to the above statement

I disagree and do not give my consent to the above statement

Additional Information

Parent Volunteer Opportunities

As a parent of an athlete on our team, we request that one or both parents be able to volunteer in an area of interest to you. The list below indicates ways that you will be able to assist the club practices, track meets, and/or behind the scenes. Please check any area(s) that you may be interested in volunteering. Coaches may be subject to background screenings.

Available Opportunities:

Coaching

Team Mom/Dad

Fundraising

Sponsorships/Donations

Travel

Photographer or Assisting

Tent Transport and set-up/breakdown

Cooking/Concessions

Recognition Ceremonies

Other:

If you would like to volunteer for more than one position, list here.:

I have read and fully understand all of the information that has been presented to me *

* Parent/Guardian Electronic Printed Signature:

* Date Electronically Signed:

* Parent Email Address for Confirmation:

Please note that Fast Lane Track Club will need a copy of your child's birth certificate as per USATF/AAU rules. Please provide your child's birth certificate when payment is made. Payment is due when your athlete reports for their first day of practice. You will be notified when we have received your complete Registration Packet. Thank you and Welcome to Fast Lane Track Club.

Derek Walker, Founder

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