BOYS & GIRLS TRACK CLUB
REGISTRATION FORM
2011-2012 TRACK SEASON
Please send a copy of your child’s birth certificate
Please send a copy of your child insurance card
Please include your child's updated physical
DATE OF BIRTH
NAME OF ATHLETE
NAME OF PARENT
HOME #
CELL #
ADDRESS
CITY
ZIP CODE
STATE
E-MAIL ADDRESS
EMERGENCY CONTACT
RELATIONSHIP
NAME
HOME #
CELL #
MEDICAL INFORMATION
CLINIC
DOCTOR
MEDICAL PROBLEMS
PHONE #
MEDICATIONS
YL
T-SHIRT SIZE
YS
YM
AS
AM
AL
HEIGHT
UNDERWEAR SIZE
WEIGHT
For Office Use Only
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Running top___________ Running bottom_____________ Body Suit ___________ Sweat Suit_________________
Boys & Girls Track Club * 678-458-7051 * www.bgtrackclub.com
http://bgtrackclub.com/registration/html