AAT Sports Academy Kings Track Club

KINGS TRACK CLUB

9526 Argyle Forest Blvd. B2-117 Jacksonville, FL 32222/ PH: (904)413-8052 Email: aatsportsacademy@gmail.com /www.aatsportsacademy.com
2021-2022 AAT SPORTS ACADEMY TRACK PROGRAM REGISTRATION FORM
Athlete's Last Name*
Athlete's First Name*
Address*

Address

Street Address Line 2

CityState

Zip
Athlete's Phone Number*
Athlete's Email*
example@example.com
Parent's Last Name*
Parent's First Name*
Address*

Address

Street Address Line 2

CityState

Postal / Zip Code
Parent's Phone Number*
Please enter a valid phone number.
Parent's Email*
example@example.com
Athlete's Age*
Athlete's Date of Birth*

MonthDayYear
Date
Athlete's Grade*
Athlete's School*
Number of years running competitively*
Schools/Clubs participated with*
Events participated in*
Each member must have: USATF/AAU membership cards. current physical, certified copy of birth certificate (Before he/she may Participate)

Winter Training $30 per session Days [MON][Tue][Wed][Thu]Spring Season $200Summer Season $150Uniform Fee: $150.00
USATF CLUB CODE: 14-1453 AAU CLUB CODE: W35W73
Kings Track Club Participation Waiver
Name of Parent or Guardian of Athlete*
Address*

Address

Street Address Line 2

CityState

Zip
Relationship to Athlete (Mother, Father, Guardian, etc.)*
As the parent or legal guardian of the above athlete Athlete's Name I fully understand that participation in athletics, in this case track and field, could result in both minor and serious injury and even death. I further understand that to minimize the risk of injury or harm. the athlete should
had have a physical within the current I(Parent/Guardian)and all risks assume any year. athlete's
participation as a member of the AAT Sports Academy and KINGS Track Club and I hereby waive and release the AAT Sports Academy KINGS Track Club, its coaches and representatives, of any and all rights for damages or injuries suffered while participating with the AAT Sports Academy KINGS Track Club during a scheduled practice, conditioning session or competition; while traveling to or from a scheduled practice, conditioning session or competition; or during any other Club related activity.
I understand and agree that Kings Track Club has my permission to take and use my child's track and field/club photographs, digital images, and video Images for official Club purposes such as, but not limited to media press releases and the club newsletter. Furthermore, I understand that with my signature I consent the right to organization's to publish photographs depicting minor engaged in field and track events of Kings Track Club, whether as an active participant or as an observer, on the official Kings Track Club Website found at the web address www.aatsportsacademy.com and any other social media associated with Kings Track Club.
I have fully read and considered all of the terms and statements contained in this release. My signature. represents that I am the person that I purport to be and in the case of parent or legal guardian that such a relationship exist between the child and myself. By my signature, also, I have read and agree to all rules and guidelines of Kings Track Club.
-Medical Waiver and Release-
I hereby acknowledge that a physician has examined registered athlete, within one (1) year of participation of Kings Track Club's training and competition seasons. Furthermore, I acknowledge that said physician has certified that said athlete has been cleared to participate and compete in the various athletic activities related to track and field participation, contests, and competitions. Furthermore, I do hereby give my consent for the above athlete to participate in Kings Track Club's Track & Field Program. I hereby waive and release any and all claims I may have against Kings Track Club Its officers, directors, employees, coaches and agents or its representatives from any and all liability due to personal injury resulting from activities sponsored by Kings Track Club or for which Kings Track Club is a participant. Moreover, I authorize the coaching staff or assigned chaperones of Kings Track Club to act as Spokesperson in granting permission for emergency Treatment/Hospitalization (including Anesthesia), if necessary for the aforementioned athlete and to make any decisions concerning the health, welfare and safety including medical treatment of this athlete during my absence. I understand that should a Health Emergency arise, I will be notified, but if I cannot be reached by telephone, such medical treatment as deemed necessary by competent medical personnel is authorized. I have fully read and considered all of the terms and statements contained in this release. My signature. represents that I am the person that I purport to be and in the case of parent or legal guardian that such a relationship exist between the child and myself. By my signature. also, I have read and agree to all rules and guidelines of Kings Track Club.
Parent or Guardian Signature*

Clear
Date*

MonthDayYear
Date
Participant/ Athlete's Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty:

KINGS TRACK CLUB

2021-2022 AAT SPORTS ACADEMY TRACK PROGRAM REGISTRATION FORM

USATF CLUB CODE: 14-1453 AAU CLUB CODE: W35W73

Kings Track Club Participation Waiver