General Release Form
MAPLE LEAF TRACK CLUB PARTICIPANT RELEASE FORM
The undersigned is registering individually or as the parent/legal guardian of a minor, child or both. As used on registration form, registrant is an adult registering for an activity individually or as a parent/legal guardian of a minor, child or both.
I recognize the possibility of physical injury associated with the participation in the Maple Leaf Track Club and the use of the Chardon High School track facility. I hereby assume any RISKS and release, discharge and otherwise indemnify the Maple Leaf Track Club, its officers, Chardon Local School District and Chardon Athletic Boosters against any claim for injuries received by the registrant {and/or minor(s)} as a result of participation in the Maple Leaf Track Club, use of the Chardon Track facility or during transportation to or from practice/competition.
The undersigned hereby gives consent for participation in the Maple Leaf Track Club. In addition, the undersigned gives consent for emergency care prescribed by a duly licensed physician or dentist. This care may be given under whatever circumstances necessary to preserve the life, limb or well being of the registrant and or minor(s). In addition, all participants must have medical health insurance.
Date___________
Print Name of Athlete/Participant: _________________________________________________
Print Name of Parent/Legal Guardian:_______________________________________________
Signature (must be 18 years old)___________________________________________________
Relationship to Minor___________________________________________________________
Address ______________________________________________________________________
_______________________________________________________________________
Email______________________________________________
Phone: _______________________ Medical Doctor:________________________
Emergency Phone:___________________ Contact:______________________________
Medical Insurance Policy #________
2010 Foot Locker Release Form
Date_______
2010 Foot Locker Midwest Championship Cross Country Meet
The undersigned is registering individually or as the parent/legal guardian of a minor, child or both. As used on registration form, registrant is an adult registering for an activity individually or as a parent/legal guardian of a minor, child or both.
I recognize the possibility of physical injury associated with the participation in the Maple Leaf Track Club and during the trip to the Footlocker Regional Cross Country Meet in Kenosha, Wisconsin on November 26-28, 2010.
I hereby assume any RISKS and release, discharge and otherwise indemnify the Maple Leaf Track Club, its officers, coaches and guardians in any claim for injuries received by the registrant {and/or minor(s)} as a result of participation in the Maple Leaf Track Club, use of the University of Wisconsin –Parkside race course or during transportation to or from the 2009 Footlocker Midwest Regional Championship meet.
The undersigned hereby gives consent for participation in the Maple Leaf Track Club. In addition, the undersigned gives consent for emergency care prescribed by a duly licensed physician or dentist. This care may be given under whatever circumstances necessary to preserve the life, limb or well being of the registrant and or minor(s). In addition, all participants must have medical health insurance.
Print Name of Athlete/Participant: _________________________________________________
Print Name of Parent/Legal Guardian:_______________________________________________
Signature (must be 18 years old)___________________________________________________
Relationship to Minor___________________________________________________________
Address ______________________________________________________________________
_______________________________________________________________________
Email______________________________________________
Phone: _______________________ Medical Doctor:________________________
Emergency Phone:___________________ Contact:______________________________
Medical Insurance Policy #________________________________________________________
General Registration Form
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