Aggieland Homeschool Track & Field Registration 2018
Athlete's Last Name *
Your answer
Athlete's First Name *
Your answer
Athlete's Birth Date *
Example: December 15, 1999
MM
/
DD
/
YYYY
Athlete's Age as of September 1st *
Your answer
Athlete's Predominant Grade Level *
Mark Only One Oval
Gender *
Mark Only One
Number of Years (Seasons) of Participation With Running Club *
Mark Only One
Number of Years (Seasons) of Participation With Experience with Track / Field (Can use N/A) *
Your answer
Athlete's Email Address
Your answer
Athlete's Cell
###-###-####
Your answer
Do you wish to receive text messages on this phone?
Mark Only One
Father's Last Name *
Your answer
Father's First Name *
Your answer
Father's Cell *
###-###-####
Your answer
Do you wish to receive text messages on this phone? *
Mark Only One
Father's Email Address *
Your answer
Mother's Last Name *
Your answer
Mother's First Name *
Your answer
Mother's Cell *
###-###-####
Your answer
Do you wish to receive text message on this phone? *
Mother's Email Address *
Your answer
Athlete's Street Address *
Your answer
Athlete's City *
Your answer
Athlete's Zip Code *
Your answer
Athlete's Home Phone *
###-###-####
Your answer
Person to notify in case of an emergency. *
Last name, First name
Your answer
Emergency Contact's Phone *
###-###-####
Your answer
Athlete's Health Insurace Carrier *
Your answer
Athlete's Health Insurance Policy Number *
Your answer
Athlete's Primary Care Physician *
Your answer
Athlete's Primary Care Physician's Phone *
###-###-####
Your answer
Parent(s) or legal guardian must sign below before player is accepted to participate in AHA Panther Running Club Activities; As parent/legal guardian of the child named herein, I hereby represent that the child has been examined by a pediatrician and is physically fit to participate in the AHA Panther Running Club Program. I understand there are inherent risks to participating in this athletic program. I hereby accept responsibility for and agree to pay all costs of medical treatment resulting from any injury suffered by my child as a result of his/her participation in the AHA Panther Running Club Program. I further agree to indemnify and hold harmles Aggieland Homeschool Athletics, Inc., Aggieland Homeschool Running Club, as well as AHA Panther Running Club officers, and its coaches, employees and/or representatives, from any and all liability, damage, or expense arising out of my child's participation in the AHA Panther Running Club Program. In the event that I cannot be reached in an emergency, I hereby give permission for a AHA Panther Running Club Program employee, coach, member, an emergency medical technician, a physician or staff member at a hospital, or any other qualified individual to administer care and provide any medical treatment deemed necessary for my child. *
Please sign your name below
Your answer
Do you wish to participate with fundraising activities? *
Do you need to order a uniform? *
Athlete's Singlet (uniform top) Size. We don't have youth sizes in Singlet but you can order a team shirt. Will order shirts on different form.
Mark Only One
Volunteer Help *
Please Check One or More
My child read and agrees with the Athlete's Pledge. On website under handbook link http://aggielandhomeschool.com/track-and-field *
Please type Childs name in the blank below.
Your answer
I read and agree with the Parent's Pledge. On website under handbook link http://aggielandhomeschool.com/track-and-field *
Please type both parent's names in the blank below.
Your answer
I read and agree with the Statement of Faith on website under handbook link http://aggielandhomeschool.com/track-and-field (The Statement of Faith is not required to participate in the Aggieland Homeschool Running Club, but is required for voting rights). *
Please type your name below. Also, enter any objections/corrections.
Your answer
I request to be a voting member of AHA. *
This may only be requested if the Statement of Faith has been signed. Please choose yes if you did sign the Statement of Faith and wish to become a voting member of AHA. Please choose no if you would like your child to participate but do not want to become a voting member of AHA.
I agree to abide by the AHA Conflict of Interest Policy. *
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