Fall 2018 DRAKE MTB TEAM ONLINE REGISTRATION FORM
RIDER INFORMATION
Please enter information for the Drake Student Rider in the section below
FIRST NAME *
Your answer
LAST NAME *
Your answer
Where did you go to middle school?
Your answer
If you are a new rider, how did you hear about the team?
Your answer
STREET ADDRESS OR PO BOX # *
Your answer
CITY OR TOWN *
Your answer
ZIP CODE *
Your answer
EMAIL ADDRESS *
The account you check most frequently.
Your answer
DATE OF BIRTH (MM/DD/YYYY) *
Your answer
GENDER *
MOBILE PHONE # *
(###)###-####
Your answer
RIDER'S ALTERNATE/HOME PHONE:
(###)###-####
Your answer
ALTERNATE PHONE RECEIVE TEXTS?
What are your goal(s) in joining the team? Get fit, have fun, win races? You tell us what will motivate you to ride! *
Your answer
Please read and acknowledge the Rules for Riders below *
I, as a Drake Mountain Bike Team Rider, agree to do each of the items below so that I can ride with the team:
Required
PARENT & EMERGENCY CONTACT INFO
NEED AT LEAST TWO EMERGENCY CONTACTS - VERY IMPORTANT!
Primary PARENT'S or GUARDIAN's First and Last NAME *
Your answer
Primary PARENT'S or GUARDIAN's MOBILE PHONE NUMBER
(###)###-####
Your answer
Primary PARENT'S or GUARDIAN'S MOBILE RECEIVE TEXTS? *
Primary PARENT'S or GUARDIAN'S ALTERNATE PHONE
(###)###-####
Your answer
Primary PARENT'S or GUARDIAN'S EMAIL *
The address checked the most.
Your answer
Secondary PARENT'S or GUARDIAN'S First and Last NAME *
Your answer
Secondary PARENT'S or GUARDIAN'S MOBILE PHONE NUMBER
(###)###-####
Your answer
Secondary PARENT'S or GUARDIAN'S MOBILE RECEIVE TEXTS? *
Secondary PARENT'S or GUARDIAN'S ALTERNATE PHONE
(###)###-####
Your answer
Secondary PARENT'S or GUARDIAN'S EMAIL
The address checked the most.
Your answer
ALTERNATE EMERGENCY CONTACT First and Last NAME
Your answer
ALTERNATE EMERGENCY CONTACT'S MOBILE PHONE
(###)###-####
Your answer
DOES ALTERNATE EMERGENCY CONTACT'S MOBILE RECEIVE TEXTS?
ALTERNATE EMERGENCY CONTACT SECONDARY PHONE
(###)###-####
Your answer
ALTERNATE EMERGENCY CONTACT EMAIL
The address checked the most.
Your answer
ALTERNATE EMERGENCY CONTACT IS YOUR:
MEDICAL INFO
DOCTOR'S First and Last NAME *
Your answer
DOCTOR'S MAIN PHONE *
(###)###-####
Your answer
MEDICAL INSURER COMPANY NAME *
Your answer
MEDICAL INSURER ACCOUNT NUMBER *
Your answer
DO YOU HAVE ANY ALLERGIES? *
IF ALLERGIES, PLEASE LIST:
Your answer
TEAM & SCHOOL INFO
YOUR GRADE *
RACING CLASS *
Best guess if you aren't sure
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