Membership

Westside Athlete Application

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Athlete Name *

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Last

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Male Female

Birthday MM/DD/YYY *

Age on 12/31/2017 *

Phone Number (HOME) *

Phone Number (Cell) *

Email *

Address *

City *

State (KY, IN, OH) *

Parent/ Guardian Name *

Zip Code *

Emergency Contact *

Emergency Contact Name *

Phone Number *

Insurance Provider *

Primary Physician *

Physical on File *

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WESTSIDE TRACK CLUB
PERMISSIONS/AUTHORIZATIONS (PLEASE READ CAREFULLY)

CONSENT FORM

I agree to let my son/daughter run with WESTSIDE TRACK CLUB. My son/daughter is in good physical health and has no physical limitations that would make track and field activities a risk to his/her life or health to the best of my knowledge.

AGE

I understand that track team members should be between the ages of 7 and 18 years of age, and that in accordance with AAU rules, my child’s competition group will be based on the age he/she will be on December 31 of the track year. (Exception: Those who are now 18 years. Must still be 18 on the last day of the National Meet; usually the first week in August)

MEDICAL RELEASE

I understand that all possible care will be taken to prevent accidents and injuries. I will not hold Westside Track Club, its coaches or agents liable for any injuries with Westside Track Club. In case of illness or accidental injury, I authorize Westside coaches (or agents acting on behalf of Westside) to seek whatever medical treatment necessary. I understand that attempts will be made to reach the parent/ guardian for all serious injuries. However, if needed for timely treatment, I authorize Westside surgical treatment to be rendered to the minor child, __________________________
Supervision of and on the advice of any physician, dentist, or surgeon.

TRAVEL

I understand that my child may participate in several track meets over the summer and that some travel may be involved. Accordingly, I hereby give permission for my child to travel with Westside on all track trips during the track season. In consideration of the advantages of these trips, I agree that Westside Track Club, its coaches, and the driver and/or owner of the vehicle used for the trips shall be exempt from liability for damages for bodily injury or property damage that might occur during the trip, except to the extent of insurance liability as provided by law. I further understand that I am responsible for all costs associated with such travel.

MONETARY COMMITMENTS

I agree to pay all fees associated with the track season by the date stated. I understand that if the fees are not paid in full by the stated deadline, my child will not run.

By signature below, I acknowledge that I have read and understood the above information. I agree to return this form as well as one copy of my child’s birth certificate and proof of physical exam (done in the last 12 months) to Westside Track Club no later than April 18, 2017.

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Membership

Club Membership

$1.00