2015/16 DRAKE MTB TErAM ONLINE REGISTRATION FORM
ABOUT YOU - RIDER
FIRST NAME *
Your answer
LAST NAME *
Your answer
STREET ADDRESS OR PO BOX # *
Your answer
CITY OR TOWN *
Your answer
ZIP CODE *
Your answer
EMAIL ADDRESS *
The account you check most frequently.
Your answer
DATE OF BIRTH *
Your answer
GENDER *
MOBILE PHONE # *
Include area code. Put "none" if you don't have a personal mobile phone.
Your answer
DOES YOUR MOBILE PHONE RECEIVE TEXTS? *
RIDER'S ALTERNATE/HOME PHONE:
000-000-0000 -- Best ALTERNATE number for you
Your answer
ALTERNATE PHONE RECEIVE TEXTS?
PARENT & EMERGENCY CONTACT INFO
NEED AT LEAST TWO EMERGENCY CONTACTS - VERY IMPORTANT!
PARENT'S or GUARDIAN's NAME (First, Last)
Your answer
PARENT'S or GUARDIAN's MOBILE PHONE NUMBER
Include area code. Put "none" if she doesn't have a personal mobile phone.
Your answer
PARENT'S or GUARDIAN'S MOBILE RECEIVE TEXTS?
PARENT'S or GUARDIAN'S ALTERNATE PHONE
Include area code.
Your answer
PARENT'S or GUARDIAN'S EMAIL
The address checked the most.
Your answer
PARENT'S or GUARDIAN'S NAME (First, Last)
Your answer
PARENT'S or GUARDIAN'S MOBILE PHONE NUMBER
Include area code. Put "none" if he doesn't have a personal mobile phone
Your answer
PARENT'S or GUARDIAN'S MOBILE RECEIVE TEXTS?
PARENT'S or GUARDIAN'S ALTERNATE PHONE
Include area code. The NEXT BEST number in an emergency.
Your answer
PARENT'S or GUARDIAN'S EMAIL
The address checked the most.
Your answer
ALTERNATE EMERGENCY CONTACT NAME (First, Last)
Your answer
ALTERNATE EMERGENCY CONTACT'S MOBILE PHONE
000-000-0000 - The VERY BEST number to reach.
Your answer
DOES ALTERNATE EMERGENCY CONTACT'S MOBILE RECEIVE TEXTS?
ALTERNATE EMERGENCY CONTACT SECONDARY PHONE
000-000-0000 - The NEXT BEST number to reach.
Your answer
ALTERNATE EMERGENCY CONTACT EMAIL
The address checked the most.
Your answer
ALTERNATE EMERGENCY CONTACT IS YOUR:
MEDICAL INFO
DOCTOR'S NAME (First, Last) *
Your answer
DOCTOR'S MAIN PHONE *
000-000-0000 - The VERY BEST number to reach.
Your answer
MEDICAL INSURER COMPANY NAME *
Your answer
MEDICAL INSURER ACCOUNT NUMBER *
Your answer
DO YOU HAVE ANY ALLERGIES? *
IF ALLERGIES, PLEASE LIST:
Your answer
TEAM & SCHOOL INFO
YOUR GRADE *
RACING CLASS *
Best guess if you aren't sure
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