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* 1. Athlete #1 -  First and Last Name?

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* 2. Athlete #1 - Date of Birth?

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* 3. Athlete #1 - Sex: Male or Female

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* 4. Athlete #1 - T-shirt size for child:

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* 5. Athlete #2 -  First and Last Name?

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* 6. Athlete #2 - Date of Birth?

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* 7. Athlete #2 - Sex: Male or Female

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* 8. Athlete #2 - T-shirt size for child:

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* 9. Athlete #3 -  First and Last Name?

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* 10. Athlete #3 - Date of Birth?

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* 11. Athlete #3 - Sex: Male or Female

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* 12. Athlete #3 - T-shirt size for child:

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* 13. Address:

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* 14. City

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* 15. Zip Code

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* 16. Parent/Guardian 1 Name:

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* 17. Parent/Guardian 2 Name:

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* 18. email address:

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* 19. Parent cellphone:

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* 20. Medical Limitations

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* 21. Do you give permission for the Columbus Panthers Track Club to use any pictures of my child(ren) for future promotional purposes.

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* 22. 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?

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* 23. 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?

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* 24. 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, Fitness Basics for Kids, LLC, 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?

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* 25. 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?

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