Wilsonville Youth Track Club Registration Form & Athlete Profile
Athlete’s Name: _________________________ DOB:____/_____/________
School:______________________Current grade:____________
Home Address: __________________________________________________________
City: ___________________________________ State: ___________ Zip: ___________
Gender: Female /Male Current Age: _____ Age on December 31, 2010:______
Parent/Guardian’s Name: ___________________________________________________
Home Phone: _________________ Work Phone: _______________________________
Cell Phone: ___________________ Fax: ______________________________________
E-mail: _________________________________________________________________
Parent/Guardian’s Name: ___________________________________________________
Home Phone: _________________ Work Phone: _______________________________
Cell Phone: ___________________ Fax: ______________________________________
E-mail: _________________________________________________________________
Emergency Contact: _______________________________ Phone: _________________
Family Physician: _________________________________ Phone: _________________
I AGREE TO ABIDE BY THE RULES OF THE WILSONVILLE YOUTH TRACK CLUB. I UNDERSTAND THAT ALL FEES ARE NON-REFUNDABLE.
____________________________________ Dated this _____ day of _____, 2011
Signature of Parent or Legal Guardian
For more info, contact The Wilsonville Youth Track Club at 541-521-5343 http://www.athletic.net/TrackAndField/School.aspx?SchoolID=39067
PARENT/LEGAL GUARDIAN CONSENT & RELEASE FORM (PLEASE PRINT)
I am the parent/legal guardian of ___________________________________________. By my signature I hereby give my consent for the above named child to participate in practices, track meets, road races, travel and other activities sanctioned, sponsored, and/or attended by The WILSONVILLE YOUTH TRACK (WYTC). I authorize the Head Coach, Coaches or Staff members to sign the standard athlete’s release forms, NWGTL, CCYTL, GRPA, USA Track & Field (USATF) and AAU (Amateur Athletic Union) documents when entering my child in any sanctioned events.
Should I (or my child) decide to withdraw from participation with The WYTC and its activities, I agree to notify the WYTC in writing, that I am withdrawing the above named child and acknowledge that all REGISTRATION FEES PAID ARE NONREFUNDABLE.
Further, in consideration of my child being accepted in the WYTC, I hereby indemnify and hold harmless The WYTC, Board of Directors, Head Coach, WYTC Coaches, WYTC Staff, WYTC assigned Chaperones and assigned Chaperones against any and all rights and claims which I have or which may arise in conjunction with my participation or travel to and from practices, track meets, road races or other activities sanctioned, sponsored and/or attended by the WYTC, NWGTL, CCYTL, GRPA, USATF and AAU.
The signee below represents that the above named child’s Medical History including allergies, medications being taken and physical impairments that will in any way effect the child’s participation have been brought to the attention of The WYTC in writing on the Medical Acknowledgement/Waiver/Consent and Release form of The WYTC.
I understand my child will not be covered by insurance provided by The WYTC and that I either have my own major Medical Insurance Policy or, if not; I will cover the expenses of any injury.
By my signature I represent that by signing, I am the person that I purport to be and in the case of parent or legal guardian that such a relationship exist between the child and myself.
PARENT OR LEGAL GUARDIAN’S SIGNATURE___________________________
PARTICIPANT SIGNATURE_____________________________________________
DATE: _________________ PARTICIPANT’S BIRTHDATE: __________________
Medical Acknowledgement, Waiver, and Consent and Release for Emergency Treatment
I (parent/legal guardian) ________________________________________________ acknowledge that a physician has examined ________________________________, registered athlete, within one (1) year of participation in The Wilsonville Youth Track Club training and competition seasons. Furthermore, I acknowledge that said physician has certified that said athlete has been cleared to participate and complete in the various athletic activities related to track and field participation, contests, and competitions. Furthermore, I do hereby give my consent for the above athlete to participate in The Wilsonville Youth Track Club. I THE UNDERSIGNED HEREBY WAIVE AND RELEASE any and all claims I may have against Wilsonville Youth Track Club. IT'S OFFICERS, DIRECTORS, EMPLOYEES, COACHES, AND AGENTS OR ITS representatives FROM ANY AND ALL LIABILITY DUE TO PERSONAL INJURY RESULTING FROM ACTIVITIES SPONSORED BY THE WILSONVILLE YOUTH TRACK CLUB, OR FOR WHICH THE WILSONVILLE YOUTH TRACK CLUB, IS A PARTICIPANT. Moreover, I authorize the coaching staff or assigned chaperones of the Wilsonville Youth Track Club to act as Spokesperson in granting permission for emergency Treatment/Hospitalization (including Anesthesia), if necessary for the aforementioned athlete and to make any decision concerning the health, welfare and safety including medical treatment of this athlete during my absence. I understand that should a Health Emergency arise, I will be notified, but if I cannot be reached by telephone, such medical treatment as deemed necessary by competent medical personnel is authorized.
________________________________________ DATE: ___________________
PARENT/LEGAL GUARDIAN SIGNATURE
AUTHORIZATION FOR EMERGENCY MEDICAL TREATMENT
In Case of illness or accident, I,____________________________________, give my permission for the
emergency medical treatment of my child, _______________________________________________, if I
cannot first be contacted. My home number is (__________) __________________________ and my cell
number is (______________) _____________________________. I understand that I am responsible for all
costs associated with the treatment of my child.Furthermore, I notify The Wilsonville Youth Track Club that
my child has the following health concerns, problems, and/or issues: ____________________
_____________________________ He/She is taking the following medications:______________________
He/She is allergic to the following medications: _________________________ Important notes related to
emergency treatment: _________________________ ______________________________________
________________________________________ DATE: ___________________
PARENT/LEGAL GUARDIAN SIGNATURE
Photo/Media Release Form
By signing below, I, __________________________________, parent or legal guardian of _____________________________________ (minor child/athlete) understand and agree that Wilsonville Youth Track Club has my permission to take and use my child’s track and field/club photographs, digital images, and video images for official Club purposes such as, but not limited to media press releases and the club newsletter.
Furthermore, I understand that by signing below I consent to the organization’s right to publish photographs depicting the minor athlete/child named above engaged in field and track events of the Wilsonville Youth Track Club, whether as an active participant or as an observer, on the official Wilsonville Youth Track Club Website found at the web address:
http://www.athletic.net/TrackAndField/School.aspx?SchoolID=39067
.
I have fully read and considered all of the terms and statements contained in this release before affixing my signature. EXECUTED this ____ day of ___________________, 20___.
Signature of Parent/Guardian Date __________________________________
Parent Volunteer Signup
Your child’s experience is directly related to the amount of parent involvement. Our team needs everyone to help in some capacity or another. The list below indicates ways that you will be able to assist the club at practices, meets and/or behind the scenes:
_____ DIGITAL PHOTOGRAPHER -All photos taken as team photographer are property of WYTC and provided free of charge for the Team to post online. Please provide all photos to one of the coach’s or team parent in a DVD/CD or Flash Drive as soon as possible.
_____ TENT SET UP/BREAK DOWN – We would like to have at least 2 tents to setup to protect the Athletes. If you volunteer for the tents setups you must be at the meet early and stay late to break down.
_____ MEET CLEANUP – Our track meets are run by other volunteer clubs and the facilities are usually provided by local High Schools, we need to show gratitude to everyone by keeping our team areas clean. Each Meet the team area will need ensure a clean area. We will provide the trash bags, but these volunteers will need to ensure everything is taken to the appropriate trash location. (Recruiting the kids would be advised)
_____ ATHELETE SHUFFLE-R -Our track meets are long and hectic. These volunteers will be the cornerstone of a successful track meet. We must ensure that the athletes are in the right location on time. If this isn’t done right, the athlete will miss their event. We will assign these parents to “Areas” to manage. ie. Long Jump area, high jump, check-in, Warm-Up.
_____ POST PRACTICE SNACKS – It would be great if we could arrange a weekly rotation of parents bringing post-workout snacks to our Tuesday and/or Saturday practice. To organize this, we would probably just need one parent willing to be the contact person and to compile a schedule.
_____ OTHER ____________________________________________________-If you have other ideas that you see as needed and/or lacking where you would like to assist please let us know what you would like to do for the team. We appreciate all levels of active help.
NAME: ________________________________________________________________
ADDRESS: _____________________________________________________________
HOME: _______________________________________
CELL: ________________________________________
E-MAIL: _______________________________________________________________
ATHLETE(S) NAME(S):
FEES
Registration Fee: $40 The primary purpose of the registration fee is to cover the operating expenses of The Wilsonville Youth Track Club including insurance, practice facilities, equipment, uniform costs and other fees incurred by the club.
Meets will vary in costs; most ranging from $5-$10. Regional and state meets will cost more. Every parent is responsible for signing up and paying for their child’s meet registration the DAY of each meet.
Each athlete must have a complete uniform. The uniform consists of a white t-shirt. We would like all athletes to wear black or blue shorts if possible.
Please make checks payable to the Wilsonville Youth Track Club in the Amount of $40.00
Or Mail to: Wilsonville Youth Track Club Sara Schaaf 6800 SW Wilsonville Road, Wilsonville OR 97070
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