Wellesley Youth Track and Field Club

USATF Club # 02-173

Registration Form

WELLESLEY WINGS - WELLESLEY YOUTH T&F CLUB - USATF CLUB # 02-173

41 Old Farm Road, Wellesley, MA 02481   781-239-3684

wellesleyyouthtrackandfield@gmail.com

www.wellesleyyouthtrackandfield.org

                2017 TRACK AND FIELD TEAM REGISTRATION FORM - MUST BE BORN in 1998-2003                 

 

Name______________________________            ___________________________________

                             (last)                                                                         (first)

Address____________________________________City_______________________State______Zip__________

                                                                                                                 

Parent's Home & Cell Phone________________/________________ Member’s Cell Phone__________________

 

Parent's Email______________________________ Member's Email_____________________________________

 

Age________ Date of Birth___________________     Returning Member________  First-Time Member_________

 

Please List Any Physical Handicaps, Injuries, Allergies________________________________________________

 

Date of Athlete’s Last Physical ______________________Grade and School Attending _____________________

Track Events/Best Performance 1. ____________________  2.____________________ 3.____________________

=================================================================================
 

Name of Parent or Guardian of Athlete _____________________________________________________________

 

Address_____________________________________City______________________State______Zip___________

 

Relationship to Athlete (mother, father, guardian, etc.) ________________________________________________

 

As the parent or legal guardian of the above athlete _____________________________________, I fully
understand that participation in athletics, in this case track and field, could result in both minor and serious
injury and even death.  I further understand that to minimize the risk of injury or harm, the athlete should
have had a physical within the past year.  I assume any and all risks associated with the above athlete’s
participation as a member of the Wellesley Youth Track and Field Club and I hereby waive and release the
Wellesley Youth Track and Field Club, its coaches and representatives, and Wellesley College of any and all rights 
for damages or injuries suffered while participating with the Wellesley Youth Track and Field Club during a scheduled
practice, conditioning session or competition; while traveling to or from a scheduled practice, conditioning
session or competition; or during any other Club related activity.
 
                                                                                  

Parent or Guardian Signature ___________________________________________Date_____________________


CLUB FEES - To be Discussed with Each Family Prior to Winter, Spring and Summer Season

Club Fees Include USATF Membership For 2017 Season

NEW MEMBERS: PLEASE INCLUDE A PHOTOCOPY OF BIRTH CERTIFICATE OR PASSPORT PHOTO PAGE FOR
USATF AGE VERIFICATION

UNIFORM SIZE    (CIRCLE ONE)    ADULT:     S      M      L

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