Student Athlete Sign Up Form

Please complete all required fields on the registration form. You will have the option to pay by PayPal after you submit the form.

Athletes' Name*
FirstLast
Age*
Date of Birth*
Address*
Street AddressAddress Line 2CityStateZIP Code
Phone*
Email
Mother/Legal Guardian's Contact Information
Mother/Legal Guardian's Name
FirstLast
Mother/Legal Guardian's Home Address
Street AddressAddress Line 2CityStateZIP Code
Mother/Legal Guardian's Work Phone
Mother/Legal Guardian's Cell Phone
Mother/Legal Guardian's Email
Father/Legal Guardian's Contact Information
Father/Legal Guardian's Name
FirstLast
Father/Legal Guardian's Home Address
Street AddressAddress Line 2CityStateZIP Code
Father/Legal Guardian's Work Phone
Father's Cell Phone
Father/Legal Guardian's Email
Medical
Family Doctor's Name
FirstLast
Family Doctor's Phone Number*
Does the athlete have any medical problems that running track might aggravate?*
- Yes
- No
Please describe the medical condition*
Does the athlete take any medication regularly?*
- Yes
- No
What medication does the athlete take?*
Emergency Contact's Name*
FirstLast
Emergency Contact's Phone Number*
Education
Last School Attended
Location (City, State)
Grade Point Average
Graduation Date
(e.g. June, 2012)
College Choices
(List up to 3)
Are you currently a member of a track team (club or school)?
- Yes
- No
Do you have any track and field experience?
- Yes
- No

Mother/Legal Guardian's Contact Information