Athlete Registration Form
Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Gender
*
Female
Male
The athlete have any chronic medical illnesses such as diabetes, asthma (exercise asthma), kidney problems, etc.?
*
Yes
No
Please explain
The athlete have any allergies?
*
Yes
No
Please explain
Please upload medical health document(s) (if applicable)
Browse Files
Drag and drop files here
Choose a file
Cancel
of
T-Shirt Size
*
Physician Name
First Name
Last Name
Physician Phone Number
Please enter a valid phone number.
Insurance
Insurance Company
Insurance Policy #
Insurance Group #
Emergency Contact
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 participating in this competition. I may have to get medical care if I have a suspected concussion or other injury.
I will respect and obey all laws and the athlete's Code of Conduct.
Date
-
Month
-
Day
Year
Date
Signature (Athlete or Parent/guardian)
Submit
Submit
Should be Empty: