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Registration
Contact
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REGISTRATION
Submit Registration and make sure to pay using our PayPal link.
$100 per season
$250 for the year
ATHLETE INFORMATION
Athlete Name
Date of Birth
Gender at Birth
Graduating Year
Phone
Email
PARENT INFORMATION
Name
Name
Phone
Phone
Home Address
City
State
Zip Code
Message
EMERGENCY CONTACT
Emergency Contact
Phone
BAKERSFIELD TRACK CLUB RELEASE FOR PARTICIPANTS
•I, THE PARENT OR LEGAL GUARDIAN OF THE ABOVE NAMED ATHLETE, HEREBY GIVE MY PERMISSION FOR MY CHILD TO PARTICIPATE IN THE BAKERSFIELD TRACK CLUB.
•I ASSUME ALL RISKS AND HAZARDS INCIDENTAL TO SUCH PARTICIPATION. SHOULD THE NEED ARISE. AND WITH THE UNDERSTANDING THAT I WILL BE CONTACTED IN THE MOST EXPEDITIOUS MANNER POSSIBLE PERMISSION IS HEREBY GRANTED TO A PHYSICIAN TO PROCEED WITH ANY MEDICAL TREATMENT DEEMED NECESSARY FOR THE BEST INTEREST OF MY SON /DAUGHTER. PERMISSION IS ALSO GRANTED TO THE ATHLETIC TRAINER TO PROVIDE THE NEEDED TREATMENT (BOTH EMERGENCY AND REHABILITATION) TO MY SON DAUGHTER.
•I DO HEREBY RELEASE, RESOLVE, INDEMNIFY, AND AGREE TO HOLD HARMLESS ALL MEMBERS OF THE RENEGADE TRACK CLUB, ITS AFFILIATED ORGANIZATIONS, AND FACILITIES UTILIZED FOR PROGRAMS, AGAINST ANY CLAIM BY OR ON BEHALF OF MY SON DAUGHTER AS A RESULT OF HIS/HER PARTICIPATION IN THE PROGRAM.
Check box
By checking this box I indicate that I have read and understood this release form
Parent/Guardian Signature
Date
SUBMIT REGISTRATION
