FORT COLLINS TRACK CLUB MEMBERSHIP APPLICATION

 

Athlete name________________________________________________Male / Female

Date of Birth ______/______/______ Age_______________(as of Dec. 31 of current year)

Parent/Guardian_________________________________________________________

Address ____________________________________Phone: (home) _______________

City __________________________Zip ________________ (work) _______________

Parent’s E-Mail______________________________ (cell)__________________

Doctors Name:________________________________Phone_____________________
Track and field events are physically demanding. If there is ANY doubt concerning the
athletes health or condition, please see your physician about participation.

PLEASE LIST ANY MEDICAL CONDITIONS FCTC SHOULD KNOW ABOUT:

(e.g.asthma)_________________________________________________________________________

________________________________________________Dated: _________________ Signature (parent/guardian)

OFFICE USE ONLY: Indoor fee______________Outdoor fee____________Birth Cert.__________

Age group_______________ USATF Card ________________________________________