Step 1 of 3 - Athlete Information 33% Athlete InformationHow many athletes are you signing up?*123456Enter Athlete(s) Name*Add athlete on each line as such: First Last Name, Gender, Age, Date of Birth, USATF#Allergies or Medical Conditions*YesNoPlease let us know if your athlete has allergies. If yes, please list below.List of allergies:*List any athlete who has allergies and what they are allergic to.Upload Birth Certificate(s) Drop files here or Please upload your athlete(s) birth certificate for us to have on file. It's required by the USATF. Parent/Guardian InformationParent Name First Last Email PhoneAddress Street Address City State ZIP / Postal Code Parent or Guardian ConsentI, the parent or guardian of the below named player for the Olympus Track Club, hereby give approval for his/her participation in any and all team or league activities during the current season. I assume all risk and hazards incidental to such participation including transportation to and from activities. I, on behalf of my child, hereby acknowledge that track is inherently dangerous and that our participation in track could kill, maim, dismember or otherwise cause my child great bodily harm. I, on behalf of my child, hereby assume the risk of our participation in any Olympus Track Club activities. I hereby waive, release, absolve, indemnify and agree to hold harmless Olympus Track Club and all staff, officials, directors, organizers, coaches and all practice and game facilities, of any liabilities and any and all injuries suffered by my child during the 2018-19 season. By signing this form, I agree to and grant permission to the team or league officials of Olympus Track Club to authorize and/or obtain medical care from a licensed medical personnel, physician, hospital or medical care center (in my absence) should the player become ill or injured while participating in team or league activities. I grant permission to Olympus Track Club to obtain proof of age for my player from school records and/or bureau of vital statistics. I understand that Olympus Track Club does not provide Health Insurance for my child, and that I am responsible for providing health insurance coverage in the event of injury or illness.Pre-Existing Conditions Consent & ReleaseAny player participating in Olympus Track Club who has a pre-existing condition, been diagnosed with a pre-existing condition, or believes they may have a pre-existing condition, must provide Olympus Track Club with a medical release note or form from a licensed medical physician in order to participate in any USATF activity. Pre-Existing conditions requiring a licensed medical physicians release include, but are not limited to, asthma, head injury or concussion, immune system deficiency, diabetes, heart problems, Hemophilia, multiple sclerosis, or any injury which occurred prior to the start of practices or games, among others. I understand that, as the parent or guardian of the below named player, I am responsible for reporting, obtaining medical release documents and providing the Olympus Track Club Staff with medical release information pertaining to any pre-existing condition of the below named player. By signing this form, I hereby waive, release, absolve, indemnify and agree to hold harmless Olympus Track Club and all staff, officials, directors, organizers, coaches and all practice and game facilities of any liabilities and any and all injuries suffered by my child during the 2019 season. All information provided will be held confidential by Olympus Track Club and only those officials, including the Olympus Track Club Staff, the player's team coach, anyone facilitated with the program and will be made aware of pre-existing conditions. This is to help ensure the safety and well-being of your child.Video/PhotographyOlympus Track Club (OTC) reserves the right to use any photograph/video taken at any tournament/league sponsored by OTC, without the expressed written permission of those included within the photograph/video. OTC may use the photograph/video in publications or other media material produced, used or contracted by OTC including but not limited to: brochures, invitations, books, newspapers, magazines, television, websites, etc. To ensure the privacy of individuals and children, images will not be identified using full names or personal identifying information without written approval from the photographed subject, parent or legal guardian.Parent No Talk PledgeThe Head Coach for each team is responsible for the actions of his or her coaching staff and the parents and family members of their athletes. The meet officials will not respond to anyone on the track or in the stands except the Head Coach. Olympus Track Club expects parents and spectators to act with dignity, maturity and integrity while a spectator at an Olympus Track Club event. Parents and spectators are expected to act as support mechanisms for the children on the track and are encouraged to cheer for all the athletes, coaches and officials. Parents and spectators are not allowed to make unsportsmanlike comments, profanities, complaints, or gestures, toward any coaches, athletes, officials or game representative’s while attending any Olympus Track Club events. By signing this document, I understand the Parent Pledge Agreement, and agree to its’ terms. Concussion Awareness EducationIn accordance with Nebraska Statute #LB260 and Iowa Section Code 280.13c, Olympus Track Club is required to provide concussion awareness information and educational materials to each player and their parent/legal guardian. Olympus Track Club has placed educational information meeting these requirements on our league website at www.olympustrackclub.com By checking off the box on this registration, I hereby agree to access this information to become educated about concussions, symptoms, treatments and causes. I also hereby agree that if I, a coach, or officials suspects that my child has suffered a concussion, I will provide a signed medical release statement from a licensed physician before my child is allowed to participate in further conditioning, practices or games for Olympus Track Club. Electronic Signature:*Parental/Guardian Consent, Waiver & Pledge Form*Yes, I/We have read and agree!NoI/We have read, understand and agree to comply with the Parental/Guardian Consent & Pledge Form as outlined above. Would you like to pay online?*YesNoPaying online will increase the price to cover credit card fees.Select # of Athletes 1st Athlete 2nd Athlete 3rd Athlete 4th Athlete 5th Athlete 6th Athlete Do you need to replace your current uniform?* Yes No First Year We will be sticking with the same uniforms, if you are a returning athlete and need a bigger size we will split the cost. $20.Enter Athlete(s) Uniform SizeWrap a tape measure around the athletes chest, waist, and indicate boy or girl.Product NameTotal $0.00 Δ This iframe contains the logic required to handle AJAX powered Gravity Forms.
