MUSTANGS TRACK CLUB
REGISTRATION FORM
Athlete’s Name ______
Street ______
City ______State ______ZIP ______
Home Phone ______Athlete’s E-mail ______
School ______Grade (Present) ______T-shirt size ___
Birth date _____/_____/______2012 Age Group* ______Boy [ ] Girl [ ]
*Young Men/Women, born in 1994 or 1995(or on/after 7/30/93) – Intermediate, 1996 or 1997
Youth, 1998 or 1999 – Midget, 2000 or 2001 – Bantam, 2002 or 2003 – Sub-Bantam, 2004 or later
Parent/Guardian #1’s Name ______
Work/Cell Phone ______E-mail ______
Parent/Guardian #2’s Name ______
Work/Cell Phone ______E-mail ______
______
Athlete’s Uniforms and clothing Sizes (circle one size for each item)
T-Shirt: Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large
L/S speed suit: Youth Small Youth Medium Youth Large Adult SmallAdult Medium Adult Large
Short speed suits: Youth Small Youth Medium Youth Large Adult SmallAdult MediumAdult Large
Hooded Sweat Top: Youth Small Youth Medium Youth LargeAdult SmallAdult MediumAdult Large
Sweat Bottom: Youth Small Youth Medium Youth LargeAdult SmallAdult MediumAdult Large
WAIVER, RELEASE, AND STATEMENT OF PHYSICAL CONDITION
In consideration of the participation of my child, ______, in the Mustangs Track & Field and Cross Country Program, I, in my own right and as next friend of such minor child, for myself and for such minor child, our heirs, successors, administrators and assigns, hereby contractually waive, relinquish and release any and all rights, claims, actions and/or causes of action we may have against the Mustangs, Executive director and Head Coach Avalon Collins, and/or any volunteer assistant coach or other club personnel for personal injury or property damage arising from, or in any wayconnected with, the Mustangs Track & Field and Cross Country Program during this calendar year.
I further certify that the minor child named above is granted my permission to participate in the Mustangs Track & Field and Cross Country Program. I am aware of the intensity of the training and competition involved and the associated risks, and I certify that such child is physically fit to participate in such program. I further certify that I know of no physical condition or
impairment that would in any way prevent such child from participating in the program.
I further understand that, with my child’s membership, I assume the responsibility of helping with the competitions that the club shall put on in whatever capacity that I am qualified for.
Dated this ______day of ______, 20______year
______
Athlete’s signatureParent’s/Guardian’s signature
“TEAM - Together Everyone Accomplishes More”