2024 Eden Valley Summer Track & Field Registration Form
Please complete this form to register for the 2024 Eden Valley Summer Track & Field Club's Summer of 2024 Season.  
Practice starts on Monday, July 1st, 2024 from 6:00 pm - 7:30 pm. 
Practice dates are July 1, 3, 8, 10, 15, 17, 22, 24, 29, and 31.
Registration Fee is $40 ($100 Family Maximum).  At this time, Registration Fees will be collected at practice (by cash or check).
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First Name *
Last Name *
T-shirt Size *
Date of Birth *
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Phone Number (xxx-xxx-xxxx) *
Street Address *
City *
State *
Zip Code *
Parent/Guardian *
Parent/Guardian Phone (xxx-xxx-xxxx) *
Other responsible adult (if Parent/Guardian can not be reached *
Other responsible adult phone number (if Parent/Guardian can not be reached *
Does the participant wear glasses/contacts *
Current Medications *
Allergies *
Other Medical Information *
Health Insurance (ie - Independent Health, Highmark, etc) *
Doctor *
Dentist *
Preferred Hospital *

Please Note: I understand there is a risk of my son / daughter / myself being injured and that this risk is inherent in all sports and activities. I further understand that the risk of injury may be severe, including the risk of fracture, brain injury, paralysis or even death.   I acknowledge that The Town of Eden, The Town of Eden Recreation Department and Eden Central Schools DO NOT have and DO NOT provide Accident - Health Insurance policies / coverage for sponsored Programs Participants, Coaches, Managers, Spectators nor Volunteers. I further understand that Participants, Coaches, Managers, Spectators and Volunteers are in fact - Participating at Their Own Risk.

In the event of injury, I hereby give authorization for emergency treatment and transportation of myself or my child.

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Date  *
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