2020 Penn Hills Eagles Track Club Registration Form - Outdoor Season-#2
Mail Registration fee to PHETC, PO Box 17606, Pgh PA 15235, or request credit card authorization form


ATTENTION: The 6-10 year old age group fills up fast and is on a first come first serve basis. (Athlete must be 6 by April 15). Confirmed registration is based on the completed and paid registration. Make sure you complete your application as soon as possible. Once that age group meets capacity, it will be closed and then all additional registrations will be placed on a wait list. If you chose to pay by credit card, a credit card authorization form must be completed and signed. You can also email that information but will still need to sign and email/mail in the credit card authorization form. Although you fill out the registration form on-line, your spot is not secure until payment is received.
Email *
Child's Last Name
Child's First Name
Address
City
Zip
Father & Mother or Guardian's Name
Daytime/Work Phone *
Cell Phone *
Email address that you want to receive correspondence *
Date of Birth *
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Age *
Gender *
School *
Allergies *
Taking any medications *
List Medications
Name and Phone Number of Child's Physician
Person to contact if parents not available *
All information will be kept confidential if requested. Are there any special medical or disabilities that requires special attention?
Insurance coverage for child *
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, TRAC, 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. *
Parent Electronic Signature *
Date Signed *
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