3D Athletics Club MMXV – Athlete Registration, Membership and Fitness waiver form
Team Membership Fees: ages 5-18yrs website:
$150 for summer2017 – includes training (April-July), select practiceAAU track meets, and uniforms. (All proceeds will assist in funding of the track club, daily activities, equipment, basic hydration resources, and to minimize fundraising requirements for major events to include end of season banquet). Cash, check, or Money Order Payable to: 3D Athletics Club MMXV (payment arrangements on case by case basis, minimum $100 initial payment).USATF, TAAF, and Qualifier meets paid separately.
District, Regional, and National Championshipspaid prior to meet and based on qualification and participation of athlete to register once they qualify to the next level, normally due within 72 hours of each qualifier meet. Paid separately due to case by case qualification at each level.
Other Required Fees below:It can be added to Team fees to have membership/registration completed by Team Admin:
USA Track and Field Membership (1-year membership $20; 2 years $40, option)- needed to compete in USATF sanctioned events and higher level Championship.The Club Code/Number has to be added on the application for Club membership.
Club Number: 295
(NOTE: Anyone 19 – 99 is welcome to join the Team and run Open or Masters as well, training provided – Good for preparation if you are an adult and would like to compete for USATF Competition on a National and International level. Cost of events paid by athlete per competition/meet. Registration/Team Fees primarily support the youth program for their growth in Athletics and competition)
AAUMembership (1-year membership, $14; 2 years $28; 3 years $42)- needed to compete in AAU sanctioned events. Any initial membership commitment to the Team for 2 years or more will receive a Coaches Discount.
Additionally, each Practice meet entered will have an entry fee. All other major meets are separate cost.
Club ID: WWDE8T
Click on Youth Athlete Membership. And for parents and/or assistant coaches, click on Non-Athlete Membership. (Parents interested in volunteer coaching must consult with Head Coach and meet minimum requirements outlined by AAU and USATF) - Brief coaching and athletic bio if interested in assisting.
* All membership registrations, meets, and training fees are non-refundable and non-transferable. And all funding is to support the Athletes and the Program, not personal use.
The Athletic Director/Head Coach credentials are noted on the Website under the “COACHES CORNER” Tab.
Very important to note that any coaching, assisting, volunteer coaching, and participating in support of athletes are required to have the basic level of qualification required to assume any support role for the Athletes and Training. Any parent, family, or friend interested in a support role will require the approval and initial interview of the Athletic Director. Plus, be required to complete a Non-Athlete Membership and the PCA Training -
Its GREAT! Training and Informative for Parents as well.
Provide a Certified Copy of the Athlete's Birth Certificate.
A requirement for all sanctioning organizations and events for age verification of athletes. Can be scanned and emailed to or a photocopy can be brought to practice. We do not want or need originals. Certified Copies only please.
Athlete’s Name (First, Last, MI) ______
Street ______
City ______State ______ZIP ______
Home Phone ______Athlete’s/Parents E-mail ______
School ______Grade (2016-17) ______
Birth date _____/_____/______Age ______Boy [ ] Girl [ ]
Parent/Guardian #1’s Name ______
Work/Cell Phone ______E-mail ______
Parent/Guardian #2’s Name ______
Work/Cell Phone ______E-mail ______
WAIVER, RELEASE, AND STATEMENT OF PHYSICAL CONDITION
In consideration of the participation of my child, ______, in the 3D Athletics Club MMXV Program, I, in my own right and as next friend of such minor child, for myself and for such minor child, our heirs, successors, administrators and assigns, hereby contractually waive, relinquish and release any and all rights, claims, actions and/or causes of action we may have against the 3D Athletics Club MMXV, Head Coach Orlando Mathews Sr., and/or any volunteer assistant coach and/or other club personnel for personal injury or property damage arising from, or in any way connected with, 3D Athletics Club MMXV Program during the 2016-17 calendar year. With the understanding that during Practices and Sanctioned Meets are governed and insured for athletes through their membership, AAU, USATF, TAAF, and Club Association.
I further certify that the minor child named above is granted my permission to participate in the 3D Athletics Club MMXV Program. I am aware of the intensity of the training and competition involved and the associated risks, and I certify that such child is physically fit to participate in such program. I further certify that I know of no physical condition or impairment that would in any way prevent such child from participating in the program. I further understand that, with my child’s membership, I assume the responsibility of helping with the competitions that the club shall put on in whatever capacity that I am qualified for.
**Advice and quick note: Athletic Physicals are free most of the time at various medical locations, especially for youth athletics during school. Please take the time get your child(s) Physical Exam complete for the school year and make a copy to submit with registration for the 3D Athletics Club MMXV as well.
Thanks,
MEDIA WAIVER
I give permission for my child’s image to be used in publicity for the 3D Athletics Club MMXV. Publicity includes all forms of media (Team website, newspaper,TV,etc.). All in good favor for the support of athlete’s growth and record history for future opportunities and qualifications to compete at the next level to include possible athletic scholarship(s), National, and International Youth Competitions.
MEDICAL TREATMENT CONSENT
As parent/legal guardian of ______, I hereby give my consent for any emergency medical treatment as approved by his/her coach or authorized adult club representative in case of illness or injury while running or in related activities. I understand that this is to prevent undue delay and to ensure my child receives prompt treatment.
Parents will be notified in case of injury, medical attention, and/or serious illness as soon as possible. The above information is for immediate treatment.
If there are any medical concerns, allergies, and/or anything that would affect the performance of athlete to include periodic medications. Please list below:
CONCERN – Medical or Other / Authorized/prescribed medication / Emergency Information Contact/Doctor/etc.…Name: ______Signature______
Now is the time to start with donations and sponsorships of your child(ren) and the Team to start preparing for the season and offsetting the cost of major meets and the opportunity compete at Nationals in California (USATF JO), YSplanti Michigan (AAU JO), and possibly TAAF which is in Texas. Of course, dependent upon qualifying at each level of District and Regional competition. The goal of all Coaches is to qualify the entire team.
HEAD COACHES DISCOUNT ON FAMILY OF 3 or more, $125 each child.
Point of Contact:
Athletic Director, Head Coach, Orlando Mathews Sr. /
210.391.1076