Dublin Celtics Track & Field Fall/Winter Form 2018-2019
Athlete Last Name *
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Athlete First Name *
Your answer
Gender *
Class Level *
Address *
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City *
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Zip Code *
Your answer
Athlete Email Address *
Your answer
Home Phone Number *
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Cell Phone Number *
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Parent/Guardian #1 Name *
Your answer
Relationship #1 to Athlete *
Mother, Father, Aunt, etc.
Your answer
Best Phone Number *
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Email Address *
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Parent/Guardian #2 Name
Your answer
Relationship #2 to Athlete
Mother, Father, Aunt, etc.
Your answer
Best Phone Number
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Email Address
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Emergency Contact *
In the event of illness or injury, notify the following person if the parent/guardian cannot be reached:
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Emergency Contact Phone Number *
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Physician's Name *
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Physician's Phone Number *
Your answer
Medical Carrier *
Your answer
Medical Carrier Policy Number *
Your answer
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