Athlete Registration Form
Parent 1
*
First Name
Last Name
Parents 2
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Format: (000) 000-0000.
E-mail
example@example.com
Emergency Contact
*
Child 1: Name
First Name
Last Name
Child 1: Date of birth
-
Month
-
Day
Year
Date
Child 1: Gender
Female
Male
Child 1: Grade
Child 1: The athlete have any chronic medical illnesses such as diabetes, asthma (exercise asthma), kidney problems, etc.?
Child 2: Name
First Name
Last Name
Child 2 Date of birth
-
Month
-
Day
Year
Date
Child 2 Gender
Female
Male
Child 2 Grade
Child 2: The athlete have any chronic medical illnesses such as diabetes, asthma (exercise asthma), kidney problems, etc.?
Child 2: The athlete have any allergies?
Child 3: Name
First Name
Last Name
Child 3 Date of birth
-
Month
-
Day
Year
Date
Child 3 Gender
Female
Male
Child 3: Grade
The athlete have any chronic medical illnesses such as diabetes, asthma (exercise asthma), kidney problems, etc.? Child 3
Child 3: The athlete have any allergies?
Physician Name
First Name
Last Name
Physician Phone Number
*
Format: (000) 000-0000.
Child 1: Insurance
Insurance Company
Insurance Policy #
Insurance Group
Child 2: Insurance
Insurance Company
Insurance Policy #
Insurance Group
Child 3: Insurance
Insurance Company
Insurance Policy #
Insurance Group
Please upload medical health document(s) and birth certificates
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Last Report Card of Athlete
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I, the athlete, agree with the following statements:
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.
Liability Waiver Form:I acknowledge that this athlete has been examined by a physician within one (1) year and has been cleared to compete in athletic activities. I do hereby give my consent for the above athlete to participate in the Supreme Performance Athletics Track Club. I will waive and release any and all claims I may have against the Supreme Performance Athletics, coaches, agents or representatives for any and all injuries sustained in this program. I authorize the coaches of Supreme Performance Athletics to make decisions concerning the health, welfare and safety including medical treatment for this athlete during my absence.
WAIVER OF PHOTOGRAPHY & VIDEOGRAPHY RELEASE:I authorize the Supreme Performance Athletics Track Club to use photos/videos, and other likeliness of myself and of my child or the child whom I have legal guardianship for any promotion materials regarding Supreme Performance Athletics and service. Such likenesses will not be sold to other parties. Promotional material bearing these likeliness may be distributed for free to the public and posted on the Supreme Performance Athletics website, etc. Supreme Performance Athletics reserves the right to use any photo or likeliness for a time period beginning from when this form is signed and ending upon written request of the participant, parent or legal guardian.
Covid-19 Acknowledgement Risk and Consent Form:The coronavirus, also known as COVID-19, has been declared a worldwide pandemic and is contagious and can be spread by person-to-person contact. As a result, federal, state and local health agencies recommend social distancing and other measures to reduce the spread of the virus. Supreme Performance Athletics is willing to conduct extracurricular activities during this time. These activities will be conducted in accordance with health and safety protocols appropriate for the activity and for the conditions at the time and as may be amended. Supreme Performance Athletics will implement plans to reduce the risk of exposure to COVID-19, however, none of these plans and mitigation efforts can guarantee complete safety, nor can they eliminate all risk of exposure. Athletes participating in the activity and programs will be required to follow these protocols and will be immediately removed from the activity or program if they do not fully comply.I, the undersigned parent or guardian of the below named athlete, agree that the below named athlete may participate in the activities and programs despite the risk of exposure to COVID-19. The athlete will report any symptoms of illness to his or her parents, guardians, coaches, and I agree to do the same. Either I, or the athlete, shall report to the coaches if the student has any contact or exposure to COVID-19. I acknowledge that the coaches retain the right to cancel or interrupt or postpone an event, track meet, activity or a practice when in the judgment of the coaches, such an act is necessary for the health, safety and welfare of the athletes and families of Supreme Performance Athletics.I have been advised of the risks of participation and I acknowledge and understand them. I have weighed the risks and benefits and hereby give my consent that the below named athlete may participate in track and field.
Date
-
Month
-
Day
Year
Date
Signature
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