Registration

Registration Form

Date

Name

Last

First

Middle

Date of Birth

Sex

Parent/guardian name

Phone

Health Insurance Name & No:

Doctor's Name:

Date

Track Experience:

No Yes

If yes, specify events and best times:

Current School:

Current School Grade:

Signature of Athlete:

Date

Signature of Parent/Guardian:

Date

If you are human, leave this field blank.

A copy of your birth certificate and emergency form must be with this application. Bring your application, birth certificate, and payment at the time you register.

WAIVER

In consideration of your acceptance of my application for participation with United Unattached Athletics (UUA), I hereby, for myself, heirs, executors, and administrators, waive release and forever discharge any and all rights and claims for damages for which I may have or which may occur to me against the United Unattached Athletics (UUA). With my association with the named club, I waive, release, and forever discharge any and all rights and claims for damages which may arise at practice, and traveling to and from practice, meets and other club activities. I further certify that I am an amateur, in good standing, eligible to compete in all events and know of no condition that will prevent me from training or competing.