Woolridge Running Club 2017-2018 Signup Form
Please complete this form prior to your child attending their first running club event.
Your Contact Information
Information for person completing this form
Name
Your answer
Phone Number
Your answer
Email Address
Your answer
Student Information
Name
Your answer
Age
Your answer
Date of Birth
MM
/
DD
/
YYYY
Grade
Teacher
Your answer
Parent/Guardian Information
Mother/Guardian Name
Your answer
Mother/Guardian Cell Phone Number
Your answer
Father/Guardian Name
Your answer
Father/Guardian Cell Phone Number
Your answer
Home Phone Number
Your answer
Primary Email Address
Your answer
Emergency Contact / Medical Information
Emergency Contact Name
Your answer
Emergency Contact Phone Number
Your answer
Relationship to Student
Your answer
Emergency Contact Name
Your answer
Emergency Contact Phone Number
Your answer
Relationship to Student
Your answer
Student's Medical Conditions, Allergies, etc.
Your answer
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