2019 Penn Hills Eagles Track Club Cross Country Registration Form
Email address *
Child's Last Name
Your answer
Child's First Name
Your answer
Address
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City
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State
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Zip
Your answer
Father & Mother or Guardian's Name
Your answer
Daytime/Work Phone *
Your answer
Cell Phone *
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Email address that you want to receive correspondence *
Your answer
Child's Date of Birth *
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Child's Age *
Your answer
Gender *
School *
Your answer
Allergies *
Your answer
Taking any medications *
List Medications
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Name and Phone Number of Child's Physician
Your answer
Person to contact if parents not available *
Your answer
All information will be kept confidential if requested. Are there any special medical or disabilities that requires special attention?
Your answer
Would the athlete be able to participate within the parameters of the program?
Insurance coverage for child *
Your answer
I give my child permission to participate in track and field/cross country/indoor events for the Penn Hills Eagles Track Club. I hereby attest that my child does not have any medical ailments that would preclude him/her from participating in any strenuous physical activities. I further understand that I am to be legally bound for my child and waive, release and forever discharge any and all rights and claims for damages which my child may have or may hereafter occur to my child against USATF, Three Rivers Association, Penn Hills Eagles Track Club or their officers, agents, representatives or successors, Penn Hills Senior High School, Linton Middle School, Penn Hills Township, Penn Hills School District, board of directors and officials, Boyce Park, Allegheny county board of directions and officials. *
Parent Signature *
Your answer
Date Signed *
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YYYY
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