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2019-2020 Track Club Registration/Waiver

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Athlete Registration form for Peoria Inner City Track Club 2018-2019 Season. Please download, complete and return this along with athlete registration fee.

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2019-2020 Track Club Registration/Waiver

  1. 1. 2019-2020 Peoria Inner City Track & Field Club Athlete Registration & Disclaimer Section I: Adult & Parent/Guardian/ Emergency Information ________________________________ _____________________________________________ Name Address _________________________________ _____________________________________________ Phone City, State. Zip __________________________________ Email Section II: Student Athlete Information Athlete Name Primary Event Grade DOB/Gender School Section III: Waiver (No Athlete can participate without delivering a valid and signed waiver & $75.00 fee) Please read this form carefully. By registering yourself, your child or ward for participation in this program/league, (hereinafter called the PICTFC) you will be waiving and releasing all claims for injuries you or your minor child/ward might sustain arising out of participation in the PICTFC. As a participant in the PICTFC, or the parent/guardian of a participant in the PICTFC, I recognize and acknowledge that there are certain risks of physical injury and I agree to assume the full risk of any injuries, including death, damages, or loss which I or my minor child/ward may sustain as a result of participating in any and all activities connected or associated with such program. I agree to waive and relinquish all claims I or my minor child/ward may have as a result of participating in the program against the PICTFC, and its officers, agents, servants, and employees. I due hereby fully release and discharge the PICTFC and its officers, agents, servants, and employees from any and all claims for injuries, including death, damage, loss which I or my minor child/ward may have or which may accrue to me or my minor child/ward on account of my participation in the program. I further agree to indemnify and hold harmless the PICTFC and its officers, agents, servants, and employees from any and all claims resulting from injuries, including death, damages and losses sustained by me or my minor child/ward and arising out of, connected with, or in any way associated with the activities of the program. In case of accident or sickness, I consent to emergency medical care provided by ambulance or hospital personnel. I hereby consent to the use of my photograph in PICTFC brochures, publications and presentations of all kinds. I have read, agree with and fully understand the above program details. ________________________________________________________________________ Parent/Guardian Date

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