Rising Stars Track Club 201 Athlete Registration Form
Please Print Clearly in Blue or Black Ink
ATHLETE INFORMATION ATHLETE NAME: _____________________________________ HOME ADDRESS: ________________________________________________________ PHONE NUMBER: ___________________________ Date of Birth: ____________________________
has my permission to participate in Rising Stars Track Club’s 201 summer track program. I release the Rising Stars Track Club, it’s board members, coaches, and staff of any responsibility for any unforeseen illnesses and/or injuries incurred by the athlete during the 201 track season. In the event of an emergency, Rising Stars Track Club has my permission to seek and obtain medical assistance as deemed necessary. Parent Initials ____________
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Rising Stars Track Club 201 Athlete Registration Form
Please Print Clearly in Blue or Black Ink
MEDICAL INFORMATION Physician’s Name
Phone:
Date of Last Physical Exam I, ______________________________________, have had a physical examination by a licensed physician within the last six months. My physician has not placed any restrictions on me that would prevent my participation in Club practices or at the track meets. If this should change at all during the season I will notify the Head Coach or his secretary immediately. Medical History
*Is athlete currently using any medications? __________ Yes
_________ No
If yes, please explain:______________________________________________________________ Is there any medical condition that could affect the athlete’s ability to perform at any track event or practices as required by the coaching staff? If yes, Please explain
UNIFORM ORDER Gender
Male
Female
Child Small
Child Medium
Child Large
Adult Small
Adult Medium
Adult Large
Uniform Size
Adult Extra-Large
RSTC Fundraising Options RSTC will participate in at least 2 fundraisers during the 201 track season in order to maintain our competitive fee structure. Every athlete registered with the Rising Stars Track Club is expected to participate in our fundraising efforts. *Please note non-compliance can result in any or all of the following consequences: unable to compete until all fees are paid, no uniform distribution until all fees are paid, suspension from the Rising Stars Track Club until all fees or paid. 2|Page
Rising Stars Track Club 201 Athlete Registration Form
Please Print Clearly in Blue or Black Ink
School Information Name of School Currently Attending: Current Grade: __________ Have you been involved in school track and field activities?
Yes
No
If Yes, Please answer the following: Event(s): _________________________________________________________
RSTC Track Fees for the Year 201 are $200.00 per athlete if registration is completed by March 30, 201 . ***After March 30, 201 , the fee will be $225.00.*** For three or more children please see the treasurer, Leslie Devereaux.
The track fees cover athlete’s uniform, AAU track membership fee, and cost for qualifiers (per athlete/per event). You may practice with the club for a week prior to registering your athlete. Once your child has practiced with RSTC for two weeks, you are required to complete registration, including fees. In the event you decide that your child will not to participate after registration is complete and closed, you may request a 50% refund until the 3rd week of practice. There will be no refunds after the third week of practice.