RICHMOND HALF-STEPPERS TRACK CLUB REGISTRATION FORM


To complete registration process: complete registration form, waiver/release forms, and code of conduct form & pay fees

Athlete Information

First Name / Last Name / Birth Date (MM/DD/YYYY) / Gender
(M or F)

Parent Contact Information

1st Parent/Guardian
(First/Last Name)
2ndParent/Guardian
(First/Last Name)

Address/City/St/Zip

Primary Phone
Secondary Phone
Primary E-mail
Secondary E-mail
Emergency Contact if no parent available (Name, Phone)
Family Physician (Name, Phone)
Allergies or
Health Concerns

Please list an email address on the registration form and register for text alerts at www.richmondhalfsteppers.org so we may keep you informed about practice, meets, and other activities.

This is how we will communicate with parents and athletes!

Uniforms

Please Mark Size / Top Size / Shorts Size
Youth Small
Youth Medium
Youth Large
Adult X-Small
Adult Small
Adult Medium
Adult Large
Adult X-Large
Adult XX-Large

Registration Fees

1 Child / $ 250.00
2 Children / $ 400.00
3 Children / $ 500.00
Uniform / $ 60.00

The registration fees include: membership fees, track meet entry fees, operating expenses, equipment, water, and nutritional snacks.

It is understood that any unpaid fees will result in my child not being able to participate in any Track Meets.

Pay Plans can be arranged.

Registration fees are due before March 1

Richmond Half-Steppers Track Club Waiver / Release

Waiver / Release Form
I, the parent / guardian of the registrant, a minor, agree that the registrant and I will abide by the rules of the Richmond Half-Steppers Track Club, and its affiliated organizations and sponsors. Recognizing the possibility of physical injury, associated with track and field and in consideration for the Richmond Half-Steppers Track Club accepting the registrant for its track and field programs and activities, I hereby release, discharge and/or otherwise indemnify the Richmond Half-Steppers Track Club, all Board members, coaches, its affiliates, organizations and sponsors, their employees and associated personnel, including the owners of the fields and facilities used for the programs, against any claims by or on behalf of the registrants as a result of the registrant’s participation in the programs and/or transportation to or from the same, which transportation I hereby authorize. I understand that in the event of an emergency, every effort will be made to contact me. Should I be unavailable and my child needs emergency medical/surgical treatment, I hereby give my permission to the physician selected by the coaching staff to secure proper treatment, to hospitalize, order injections, anesthesia or surgery for my child as named on this registration form.
I/WE HAVE READ THE ABOVE WAIVER AND RELEASE, UNDERSTAND
THAT I/WE HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT AND
SIGN IT VOLUNTARILY.
______
Parent or Guardian (Signature/Relation) Date
______
Parent or Guardian (Signature/Relation) Date
Printed Name of Parent or Guardian ______
Printed Name of Participant ______
Address of Participant ______

Richmond Half-Steppers Track Club

PHOTO/MEDIA RELEASE FORM

I ______, parent or legal guardian of, ______, minor child/athlete understand and agree that the Richmond Half-Steppers Track Club has my permission to take and use my child's track and field/club photographs, digital images, and video images for official Club purposes such as, but not limited to media press releases and the club website/newsletter. Furthermore, I understand that by signing below I consent to the organization's right to publish photographs depicting the minor athlete/child named above engaged in field and track events of the Richmond Half-Steppers Track Club, whether as an active participant or as an observer, on the official the Richmond Half-Steppers Track Club website found at the web address: www.richmondhalfsteppers.org.

I have fully read and considered all of the terms and statements contained in this release before signing my signature.

______

Parent / Guardian Signature Date