Athlete Registration Form

Athlete Registration Form

Give Back Through Track Fundraiser August 19th (4:00 to 7:00)
Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
FemaleMale
Middleschool (7th through 8th)Elementary School (kindergarden through 6th)
Which grade did you attend this past school year and where. (ex: 4th grade at Howe Manning)
YesNo
Mile (Middleschool only)800m100m hurdles100m400m4x100m Relay (Make sure all 4 teammates sign up for this as 1 of their 3 events)Long JumpJavelin
YesNo
Please explain
YesNo
Please explain
Parent/Guardian & Emergency Contact
I am physically able to take part in the activities.I know there is a risk of injury. I understand the risk of continuing to play sports with or after a concussion or other injury. I may have to get medical care if I have a suspected concussion or other injury. I also may have to wait 7 days or more and get permission from a doctor before I start playing sports again.I will respect and obey all laws and the athlete's Code of Conduct.
Date

MonthDayYear
Date
Signature (Parent/guardian)

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For registration payment please Venmo @terri-gibeau $15 and confirmation emails will be sent prior to the event. Please use the athlete's name for the Venmo comment. Please note that once you register we will not be able to give refunds since all of the money will be used to support the meet and then be donated. ALL Registrations are due no later than Friday, August 16th. For any questions please email madisongibeau268@gmail.com.
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