2023 USG Track Club Conditioning/Tryout Form

Athlete Information

PLEASE READ CAREFULLY

Thank you for your interest in running for the USG Track Club. The philosophy of our program is to give the youth in the Pinellas County area an opportunity to compete at a National level.

By Signing Up Below I/We understand:

- There is a significant time commitment to you, your team and teammates.

- This is a competitive program.

- Paying the registration fee of $135 does not guarantee you a spot on on the team

- Practices and track meets are mandatory. Missing practices and track meets will affect your spot on the team.

- Track comes after major school and religious functions (ie. band, orchestra, science fair, etc.)

- We offer our own strength and conditioning program that will be mandatory to train at USG training facility

- I/We the parent(s) of a athlete trying out for USG Track Club, hereby give my/our son/daughter approval to his/her participation in any/all activities during the upcoming season.

- I/We assume all risks and hazards incidental to such participation including transportation to and from activities, and I/We do herby waive, absolve, indemnify and agree to hold harmless of USG Track Club, participants and persons transporting my/our child – except to the extent and in the amount covered by liability insurance.

- I/We understand Medical insurance will NOT be provided by USG Track Club.

- I/We will furnish a certified birth certificate upon request.

USG Track Club Conditioning/Tryout form

Please fill out the secure online registration form below for each athlete. Following submission, you will need to make payment for the tryout fee through cash app, paypal or venmo. The athlete's spot will only be reserved upon receipt of payment. If you have any questions, please feel free to contact us at usgtracknfield@gmail.com.

Athlete's Full Name*

First NameLast Name

School Grade*

Athlete's Age*

Date of birth

Date

School Name*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Uniform Information

Uniform Top Size*

Shorts Size*

Parent/Guardian Information

Full Name*

First NameLast Name

Home Number*

Area CodePhone Number

Cell Number

Area CodePhone Number

E-mail*

Emergency Information

Emergency Contact's Name*

First NameLast Name

Relationship*

Phone Number*

Area CodePhone Number

Alt. Phone Number

Area CodePhone Number

YesNo

Please describe.*

YesNo

Please explain any instructions.*

Informed Consent and Acknowledgement I hereby give my approval for my child’s participation in any and all activities of USG Track Club during the selected session. In exchange for the acceptance of said child’s candidacy by USG Track Club, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless USG Track Club. and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of travel to, participating in, or returning from practices, exhibitions, parades or competitions conducted during the season. There is a risk of being injured that is inherent in all sports activities, including track and field. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death. In case of injury to said child, I hereby waive all claims against USG Track Club. including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. Furthermore, all images and videos of USG Track Club. are the property of USG Track Club and can be used for any promotional consideration. I hereby state that I have carefully read the above waiver. Acceptance and understanding of this agreement are hereby acknowledged.

I have read and agree to the Informed Consent and Acknowledgement.

Please initial*

Medical Release and Authorization As Parent and/or Guardian of the named athlete, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed. Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named athlete. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me. Permission is also granted to the USG Track Club. Director/Coach/Team Parent to provide the needed emergency treatment prior to the child’s admission to the medical facility. Release authorized on the dates of the registered sessions. This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.

I have read and agree to the Medical Release and Authorization.

Please initial*

Program Policies and Terms: Refunds will only be provided, regardless of reason, up to 24 hours prior to the start of the registered program if a athlete chooses not to participate. Notification of non-participation must be given to the USG Track Club by email. Emails should be sent to usgtracknfield@gmail.com. An acknowledgement email will be sent to verify withdrawal from the program was received. Within 24 hours to the start of the registered program, refunds will not be given, regardless of circumstances. SEASON: If placed on a team and player accepts, payment for the full program fee is deemed due and owing to USG Track Club and fully earned by USG Track Club upon the athlete's acceptance into the USG Track Club program. There are NO REFUNDS or CREDITS for the program fee if an athlete voluntarily chooses not to continue with the USG Track Club program or is removed from an USG Track team due to disciplinary conduct prior to the end of the season. Additionally, any athlete who voluntarily leaves the program or is removed from a team prior to the end of the season will be responsible for immediate payment of any remaining balance due on their account including the FULL program fee. Furthermore, if placed on the USG Track Club team and upon acceptance of the athlete, a parent/guardian and/or guarantor must agree to our FULL Policy and Terms Agreement, which will be provided at the time of team selections. This must be completed prior to the athlete being fully accepted into the program.

I have read and agree to the Program Policies and Terms.

Please initial*

Our records indicate you have selected to participate in the USG Track Club TEAM Conditioning/TRYOUT.

Yes, this is correct.

Confirmation

By entering the information below, I am delivering an electronic signature that will have the same effect as an original manual paper signature. The electronic signature will be equally as binding as an original manual paper signature.

Parent/Guardian Full Name*

First NameLast Name

Parent/Guardian Signature*

Confirmation E-mail*

After completing this form, please click Submit Form. You will receive a confirmation email. If you do not receive the email within a few minutes, please check your spam; otherwise, please contact us at usgtracknfield@gmail.com.