2017 DuPage Track Club Registration Form
If this is your first year with the club we will need a copy of your athletes birth certificate in order to compete. You may not be able to compete in the state, regional or national meet if you do not get your athletes birth certificate in on time.

Please fill out this form completely.

Athletes Last Name
Your answer
Athletes First Name
Your answer
Main Event Interest
Athletes Date of Birth
MM
/
DD
/
YYYY
Male/Female
Is the athletes a male or female?
Guardian Last Name
Your answer
Guardian First Name
Your answer
Guardian Cell Number
Your answer
Guardian Work Number
Your answer
Guardian Email Address
Your answer
Athlete Email Address
Your answer
Guardian Street Address
Your answer
Guardian City
Your answer
Guardian Zip Code
Your answer
Secondary Last Name
Your answer
Secondary First Name
Your answer
Secondary Cell Number
Your answer
Secondary Email Address
Your answer
Jersey Size - All Sizes in Boys/Mens
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?
I acknowledge that by signing an athlete up for the club I am responsible to provide a worker such as myself or another person age 18 or over for our home meet on Saturday, July 15. If you cannot provide a worker you will be asked to pay $40 to pay a high school athlete to take your place.
Required
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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