Columbus Panthers Club Registration
1.
Are you interested in Indoor or Outdoor Track?
Indoor Track
Outdoor Track
Training Only
2.
Athlete #1 - First and Last Name?
3.
Athlete #1 - Date of Birth?
4.
Athlete #1 - Gender: Male or Female
Male
Female
5.
Athlete #1 - Medical Limitations
6.
Athlete #1 - T-shirt size for child:
youth extra small (2-4)
youth small (6-8)
youth medium (10-12)
youth large (14-16)
Adult small
Adult Medium
Adult Large
Adult XL
7.
Athlete #2 - First and Last Name?
8.
Athlete #2 - Date of Birth?
9.
Athlete #2 - Gender: Male or Female
Male
Female
10.
Athlete #2 - Medical Limitations
11.
Athlete #2 - T-shirt size for child:
youth extra small (2-4)
youth small (6-8)
youth medium (10-12)
youth large (14-16)
Adult small
Adult Medium
Adult Large
Adult XL
12.
Athlete #3 - First and Last Name?
13.
Athlete #3 - Date of Birth?
14.
Athlete #3 - Gender: Male or Female
Male
Female
15.
Athlete #3 - Medical Limitations
16.
Athlete #3 - T-shirt size for child:
youth extra small (2-4)
youth small (6-8)
youth medium (10-12)
youth large (14-16)
Adult small
Adult Medium
Adult Large
Adult XL
17.
Address:
18.
City
19.
Zip Code
20.
Parent/Guardian #1 Name:
21.
Parent/Guardian #1 email address:
22.
Parent/Guardian #1 cellphone:
23.
Parent/Guardian #2 Name:
24.
Parent/Guardian #2 cellphone:
25.
Parent/Guardian #2 email address:
26.
Do you give permission for the Columbus Panthers Track Club to use any pictures of my child(ren) for future promotional purposes.
Yes
No
27.
In the event I cannot be contacted, do you give permission for your child to be transported by ambulance or aid car to an emergency center for treatment?
Yes
No
28.
I further consent to the disclosure of health information and to the medical, surgical, and hospital care treatment, and procedures to be performed for my child by a hospital when deemed immediately necessary or advisable by the physician to safeguard my child’s heath?
Yes
No
29.
Recognizing that the Columbus Panthers Track Club and directors will do its best to ensure a safe experience, I understand that accidents may occur both from the child’s participation in youth sports activities and from transportation to and from tournament sporting events. I agree to assume these risks.
By signing below, I do herby, for myself, my heirs, executors, and administrators, waive, release, and forever discharge any and all rights and claims for damages which may have or may hereafter accrue to me against the
Columbus Panthers Track Club, AAU Track & Field, Franklin County Parks & Recreation, Southwestern City School District in Franklin County, Ohio, Columbus Public School System, coaching staff, volunteers, independent contractors, directors, agents, representatives, successors, and/or assigns for any and all damages which may be sustained by me in connections with my association with or entry in any sporting tournament, or which may arise out of traveling to or participating in and returning from said sporting tournament?
Yes
No
30.
I have read and understand the above and have completed this form to the best of my ability. I also support the Columbus Panthers Track Club philosophy, which is based on participation, fun, physical fitness, skill development, teamwork, fair play, and volunteer leadership?
Yes
No
Current Progress,
0 of 30 answered
