Utah Track Club Registration Form 2019

Home Address *

Events *

Sprint Distance Field Events
Uniform - Included in Track Club Fee *
*Team sweats, parent t shirts, and parent jackets will be available to order the first week of practice.
Parent/Guardian Information
Parent First Name *
Parent Last Name *
Parent Email *
example@example.com
Parent Phone # *

Area Code Phone Number
What talents do you have that could help the track club?
Medical Health *

To the best of my knowledge, there are no physical or other conditions, which will interfere with my child's participation. I certify that my child/ward has had a medical examination within the last 12 months and, in the physician's opinion, is physically capable of completing the sports for which he/she has registered
Signature *
Today's Date *

Month Day Year
Date Date Picker Icon
Emergency Contact
Name *

First Name Last Name
Relationship to Athlete *
Email *
example@example.com

Utah Track Club Fee *

Registration Club Fee $ 149.00

Total $ 0.00

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Comments/Concerns
Should be Empty:

Athlete(s) Information