FFTC 2010 Athlete Registration Form
Athlete’s Name (Last) ______________(MI) ___(First__________________
City _____________ Zip __________ Home Phone____________________
Date of Birth ______/______/_____ Male ____Female __Current Age____
Current School _______________________________________________
Cell Phone ____________Family E-Mail Address ____________________
Parent/Guardian ________________ Relationship ___________________
Address (if different)__________________________________________
Home Phone (if different) _____________ Work Phone ______________
Email Address (if different from above) _____________________________
Emergency Contact Name ________________________Phone__________
Financial Information: Fees are $85.00 for the 1st child, $65.00 for the second child, three or more children family plan. Uniform deposit will be $15.00 refundable at the end of season, when uniform is returned in good condition. There is a reduced season fee (end of school district season) for high school athletes that register before May 31st for the 2010 season. Fee payment must be made no later than the first day of practice.
Registration fee of $30.00 will be non-refundable after the first scheduled track meet.
A copy of your athlete’s birth certificate, picture and insurance card must accompany this application.
(If athlete was a member last season, birth certificate will be on file)
Waiver: In consideration of your accepting this application, I do hereby, for myself, my heirs, executors, administrators, waive, release and forever discharge any and all rights and claims to me against the FAST FORWARD TRAK CLUB, its officers, directors, volunteers, sponsors, coaches and others aiding in the program, etc. and/or assigns for any and all damages which may be sustained and suffered in connection with said association or entry and/or arising out of traveling to or participating in and returning from practices and meets. It is expressly understood by the undersigned that he/she is solely responsible for any costs arising out of any bodily injury or property damage sustained through participation in normal or unusual activities of this program. The undersigned also understands that a part of their registration fee covers the Amateur Athletic Union insurance card for their participation.
I HEREBY AUTHORIZE ANY REGISTERED PHYSICIAN OR LICENSED HOSPITAL TO PERFORM ANY TREATMENT THEY JUDGE NECESSARY IN AN EMERGENCY IF I AM UNABLE TO BE REACHED BY PHONE.
I HAVE CAREFULLY READ AND UNDERSTAND COMPLETELY AND CLEARLY THE ABOVE PROVISIONS AND AGREE TO BE BOUND BY THEM.
Authorized Parent (please print) Authorized Parent Signature
STATE OF FLORIDA
COUNTY OF ____________________
The foregoing instrument was acknowledged before me this _____day of ______, 20___, by:
Signature of Notary Public-State of Florida
Name of Notary Typed, Printed or Stamped
Personally Known _______ OR Produced Identification _______
Type of Identification Produced __________________________
Please Check One:
__________ Youth Small __________ Adult Small
__________ Youth Medium __________ Adult Medium
__________ Youth Large __________ Adult Large
__________ Adult X-Large
Please list any known allergies or medication being taken: