Exit this survey 2017/18 Online Athlete Registration Enter Athlete Information Question Title * 1. Athlete Information First Name Last Name Phone Number with Area Code Street Address or P.O. Box City, State Zip Parish School Grade Birthday (Month/Day/Year) Gender Ethnicity WheelChair User? (Yes/No) T-Shirt Size (Adult Sizes Only) S / M / L / XL / XXL Medical Insurance Company Name or Medicaid, Policy Number or 16 Digit Medicaid Number Emergency Contact Person, Phone Number with Area Code Question Title * 2. Enter your Age on Day of Race, and your Division: Bantam (5-9), Junior (10-14), Senior (15 - 22), Master (Over 22) Age on Day of Race Division Question Title * 3. GUMBO Classification: Enter one of the following for the Track and Field Classes: 1a, 1b, 2, 3, 4, 5, 6, 7, 8, 9, 10, V1, V2, V3, V4 Track Field Question Title * 4. If you have a national WASUSA classification: Enter your track and field classifications here. Track Field Question Title * 5. Disability Visually Impaired Neuromuscular Amputee Dwarf Spinal Cord Injured Cerebral Palsy Other Question Title * 6. If you chose "Other", in the above question, please describe your disability. Question Title Question Title * 7. For Regional Meets use the above table and choose a maximum of 5 events that are open under your classification AND select the 800M (if qualified). For the State Invitational select the events in which the athlete qualified. 20m Electric 20m 60m Electric 60m Electric Weave 60m 100m 200m 400m 800m Long Jump Javelin Slalom Precisions Toss Soft Shot Club Throw Discus Shot Put Softball Question Title * 8. Select your competition site(s). Acadiana North South Crossroads Delta State Invitational Question Title * 9. Coach Information Name Street Address or P.O. Box City, State Zip Home phone number with area code Cell phone number with area code email address Done