Holts Summit Heat Registration Form

Participant Name

First NameLast Name

2nd Participant Name (if registering more than one child)

First NameLast Name

3rd Participant Name (if registering more than one child)

First NameLast Name

Participant Birth Date

MonthDayYear

2nd Participant Birth Date

MonthDayYear

3rd Participant Birth Date

MonthDayYear

Participant Shirt Size

2nd Participant Shirt Size

3rd Participant Shirt Size

Allergies/Medical Conditions

Parent Contact Name

First NameLast Name

Parent Contact Name

First NameLast Name

Parent Contact Phone

Format: (000) 000-0000.

Parent Contact Phone

Format: (000) 000-0000.

Parent Contact E-mail

example@example.com

Parent Contact E-mail

example@example.com

Have you previously participated in the Holts Summit Heat?

Comments / Questions:

I acknowledge that cross country is a sport that requires physical exertion and has some risk of injury. I have no concerns about my child’s ability to handle the level of activity necessary to participate. The child or children named above has/have my permission to participate in the Optimist program. I hereby give my consent to the above applicant to be treated by a physician or surgeon in case of sudden illness or injury while participating in the above event. I release liability of the Holts Summit Optimist Club in the event of any accidents or harm that my child may encounter while participating in the program. I also agree to all their terms & conditions and understand this is a youth sporting event. Any portrayal of un-sportsmanship like conduct from the player, parents, or individuals associated with the league may result in immediate dismal without refund. Once you click "Submit Form" below, you will be taken to a secure PayPal site to complete your payment. Holts Summit Optimist is a PayPal verified merchant. You may pay by debit/credit card or PayPal account.

Heat Registration

Participant Cost

$70.00 Quantity

Enter coupon

Total

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

Heat Registration*

Payment Methods

Heat Registration