2025 XC Membership Registration Form

Membership Registration Form

2025 Cross Country
Parents Name

First NameLast Name
Childs Name

First NameLast Name
Childs Birthdate

MonthDayYear
Date
Jersey Size (Youth and Adult Sizes available)
if already have one leave blank
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Parents Email
example@example.com
Registration Options: please VENMO payment to @Brad-Peterson-26 or PayPal to bradpetersonmanagement@gmail.com to secure your spot. Meets are Paid for Separately*
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REGISTRATION COST FOR NOVEMBER START - Deadline Oct. 1High Schoolers would start now - also for Ft. Wayne Kids with Derek Leininger
$200.00



REGISTRATION COST FOR OCTOBER START - Deadline Sept. 1Middle Schoolers and some High Schoolers if season has ended- also for Ft. Wayne Kids with Derek Leininger
$250.00



REGISTRATION COST FOR SEPTEMBER START This is more Elementary and Middle School focused
$300.00



REGISTRATION COST FOR CLUB ONLYNO WORKOUTS PROVIDED, meet entries, uniform are all additional
$100.00



REGISTRATION COST FOR ADDITIONAL CHILD
$150.00



Team JerseyPlease allow 3-4 weeks for delivery
$45.00 Quantity
Item subtotal:$0.00



Total

$0.00
By Clicking Submit I acknowledge and agree to the following:

I do not know of any medical reason my child should not participate in track and field. Furthermore, I assume all risk of injury, damage or loss of property due to any cause. On behalf of myself and my child, I agree to hold harmless and not to sue HP Distance, coaches or volunteers; USA Track & Field, its officials or volunteers; the Indiana Youth Track Association, its officials or volunteers; YES Athletics; or any other track club hosting a meet my child will attend, along with the owner/lessee of all facilities, and their volunteers and officials; and I do hereby release them from liability, loss, claims, demands, court costs, settlement costs, attorney fees and any other expenses.

I grant permission to coaches to authorize emergency medical treatment if I cannot be reached.

I give permission for my child to be photographed and for his/her name, likeness, image, voice, video, and statistics to be exhibited and distributed in any format.

I also agree to abide by the Terms and Conditions outlined on the hpdistance.com website.
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