St. Joseph Athletic Association

Track Registration Form

Mom:

Dad:

Home Phone:

Home Phone:

Alt. Phone:

Alt. Phone:

Email:

Email:

Address

City

Zip

Child's Full Name

M/F

Birth Date

Parish

T-Shirt Size *

1)

2)

3)

4)

5)

* Please mark size as YOUTH (ys, ym, yl) or as ADULT (as, am, al, axl)

Fees

No. of children

Make check payable to:

x fee/child

x $25

St. Joseph Athletic Association

Total fee

* Not to exceed $75

Rcv'd

Parental / Guardian consent and medical authorization

I (we) being the legal guardian of the above applicant/applicants, consent to their participation in this St. Joseph Athletic

Association's sports program.

I (we) authorize St. Joseph Athletic Association to request medical treatment, if necessary, to insure the participant's well being.

I (we) hereby waive St. Joseph Athletic Association and its agents any liability, judgment, or demands for damages

arising as a result of injuries sustained during participation in any St. Joseph Athletic Association sponsored sports program.

Parent/Guardian Signature

Date

Parental / Guardian parish certification

I (we) certifiy my child lives within the St. Joseph parish boundaries, or is a registered member of St. Joseph parish or school.

Parent/Guardian Signature

Date