Faith Track Club, Inc.

"We Run By FAITH!"

Registration Form

Athlete Name: _________________________

Signature: _____________________________

Birthdate Date: _________________________

Email: ________________________________

Parent/Guardian Name: ___________________

Relationship: ___________________________

Address: _______________________________

Email: _________________________________

Telephone:

Home: ________________________________

Work: _________________________________

Cell: __________________________________

Insurance Company Name: _______________

______________________________________

Address & Telephone #: __________________

______________________________________

Physician's Name: ______________________

Telephone #: ___________________________

(All kids 8 and under, fees will be $150)

6280 Calion Drive, Baton Rouge, LA 70812 (225) 202-8431 HEAD COACH: Rev Burnett G. King, Sr.

ATHLETE

My child has permission to participate in all summer league track and field events during the present season. Parents should provide transportation to the track meets, unless otherwise stated by FTC. In the event that emergency medical treatment is required, I am giving my consent to FTC officials to administer and/or arrange for reasonable treatment in the absence of the parent or guardian. In the absence of the parent, an FTC official will notify the parent of the emergency as soon as possible.

Parent/Guardian Signature: ___________________________________

TOTAL FEES ARE $250 (which includes the $50 application ) fee along with uniform fee must be paid by the deadline.

MOTTO: "For We Run By Faith, Not By Sight"

FAITH TRACK CLUB REGISTRATION & WAIVER OF LIABILITY FORM

Emergency Contact

If your child/children did not participate in the previous season, we will need a copy of their birth certificate along with this form.

This form must be completed and returned with a non-refundable $50 application fee (per child) prior to your child(ren) beginning practice with the team.