2019 2 Week DTC Registration Form K-9th Grade
Please fill out this form completely.
Athletes Last Name *
Athletes First Name *
Athletes Date of Birth *
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DD
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Male/Female *
Is the athletes a male or female?
Guardian Last Name *
Guardian First Name *
Guardian Cell Number *
Guardian Work Number *
Guardian Email Address *
Alternate Email Address
Guardian Street Address *
Guardian City *
Guardian Zip Code *
Secondary Last Name
Secondary First Name
Secondary Cell Number
Secondary Work Number
Secondary Email Address
T-Shirt Size - All sizes in Boys/Mens *
DuPage Track Club has my permission to submit my child’s name and/or photo to the DTC website or news articles in local newspaper *
How are you making payment? *
In consideration of your accepting this application, I do hereby, for myself, my heirs, executors, administrators, waive, release and forever discharge any and all rights and claims to me against the DUPAGE TRACK CLUB, District #108 or USATF, its officers, directors, volunteers, coaches and others aiding in the program, etc. and/or assigns for any and all damages which may be sustained and suffered in connection with said association or entry and/or arising out of traveling to or participating in and returning from practices and meets. It is expressly understood by the undersigned that he/she is solely responsible for any costs arising out of any bodily injury or property damage sustained through participation in normal or unusual activities of this program. The undersigned also understands that they are required to purchase a USATF card for their participant. I HEREBY AUTHORIZE ANY REGISTERED PHYSICIAN OR LICENSED HOSPITAL TO PERFORM ANY TREATMENT THEY JUDGE NECESSARY IN AN EMERGENCY. Please print your name below. *
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