CL Stars Registration Form

REGISTRATION FORM
ATHLETE INFORMATION
Name

First NameLast Name
Grade
Age
Birth date

MonthDayYear
Date
Gender
School
Tshirt Size
PARENT OR GUARDIANS INFORMATION
Name

First NameLast Name
Relationship
Home Phone
Cell Phone
Address

Address

Street Address Line 2

CityState / Province

Zip
Email
example@example.com
Name

First NameLast Name
Relationship
Home Phone
ell Phone
I
hereby give permission for my child
to participate with the C.L. Athletics Stars Track Club spring/summer Track Program. I further release the coaching staff and the C.L. Athletics Stars Track Club from any responsibility for bodily injury my child may receive while participating in the program. I understand that I am responsible for any medical fees accrued by my child as a result of medical attention. I also grant permission to the C.L. Athletics Stars Track Club's president or his/her designee to complete all membership forms and registration materials required by the USA Track and Field Association and Amateur Athletic Union for participation in local and national meets. I CERTIFY: I am the Parent or Guardian of the above names applicant and the information is true to the best of my knowledge.I also acknowledge the reserved rights of the Stars Track Club and understand that the Stars Track Club does not provide medical
Signature of Parent or Guardian

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Todays Date

MonthDayYear
Date
MEDICAL FORM
Doctors Name
Phone
Address

Address

Street Address Line 2

CityState / Province

Zip
Insurance Carrier Name
Policy Number
Allergies
Medication
MEDICAL REI EASE HISTORY FORM
Applicants Name
C.L. Athletics Stars Track Club State of Texas County of: Fort Bend and Surrounding Areas Known all men by these presents that a request has been made to the CL ATHLETICS STARS TRACK CLUB, it's agents, and/or it's designees (1) to provide youth activities for the youth (whether one or more) of the undersigned parents or guardian; (2) to transport by automobile and/or vehicle said youth to various locations; and (3) to seek and obtain medical assistance on behalf of the youth in the event coach and staff, and/or it's designees determine the need of same. In consideration of the granting of such requests, I, the undersigned, as legal parents or guardian of the above listed youth do hereby release and forever discharge any and all claims, demands, liability, legal action or cause of action on account of mishap to the above listed youth which may occur as a result of furnishing youth activities, transportation and/or seeking medical assistance on behalf of said youth. In case of an emergency, please try to contact my family doctor first at:
Doctors Name
Doctor's Phone Number
Has the applicant or any member of the applicants family suffered from any major illness or have current health issues
If he/she is not available, the doctor on call at any hospital has my permission to treat my child. In case of an emergency, I can be reached at:
Home Phone Number
Work Phone Number
ParentGuardian Signature

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Date

MonthDayYear
Date
USA TRACK& FIELD
USATF Membership Application New Member) Renewal (from previous year - USATF Number

Please print or type information
Name

First NameLast Name
Initial
Address
City
State
Zip Code
Age Today
USA CitizenYesNoIf no, country of Citizenship
If no country of Citizenship
Club No
Club Name
Your membership will be emailed to you Your email address will not be shared with anyone
example@example.com
Please check all appropriate sports codes here: TrackFieldRoad Running/LDR Cross CountryUltra-Marathon

Please use the codes below-youmay indicate one or more categories.

CH: Coach-uncertified CD: Developmental certified C1: Coach Level 1 certified C2: Coach - Level 2 certified C3: Coach - Level 3 certified

OF: Official -uncertified OA: Official - Association ON: Official National OM: Official Master

By signature below, I, a prospective member of USA Track & Field, agree to abide by the applicable USATF Bylaws, Operating Regulations, and Competition Rules for my level(s) and category(ies) of membership.
Signature If an athlete is under age 18 parent or guardian must sign

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Signature (If an athlete is under age 18, parent or guardian must sign) Date of Application
(MM-DD-YYYY)
Important information: Memberships are on a calendar year basis, and expire on December 31. However, if you join between November 1 and December 31 of the current year, the membership will be valid for the following year as well. Youth members: New or lapsed memberships must submit a copy of birth certificate or other ID.

Check here if you do not wish your address used as part of a direct mail list.
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REGISTRATION FORM

ATHLETE INFORMATION

PARENT OR GUARDIANS INFORMATION

MEDICAL FORM

MEDICAL REI EASE HISTORY FORM

USA TRACK& FIELD