2024 Track Participant Registration Form

* Required Fields

Fee: $75.00

This is the participant registration form for St. Philip's Track. Ages are 4-14. Practice will be on Tuesday & Thursdays. Please look for an email for further information.

The participant registration fee is $75 which includes the uniform. If you elect to pay online using a debit or credit card, you will be prompted to do so once you complete this form and your registration will be complete once this form is submitted and the online payment is made. If you elect to pay in person, you must complete this registration form and then submit a money order, cashiers check, or cash to St. Philip's School & Community Center with both your name and the child's name referenced. Registration and payments must be received by April 19th This is non negotiable.

Participant Information

*First Name

*Last Name

*Gender

Male
Female

Don't type in this field

*Grade

*Date of Birth

Birth Certificate Submitted

*Street Address

*City

*State

*Zip Code

*School

*Jersey Size

Participant Medical Information

Please check any medical conditions that apply

Convulsions

Epilepsy

Diabetes

Asthma

Hyperactivity

Hayfever

Please list other Medical Conditions/Allergies

List any and all medications

Evidence of Medical Physical Submitted

Parent / Guardian 1 Information

*Guardian 1 First Name

*Guardian 1 Last Name

*Relationship

*Guardian 1 Email

Home Phone

Cell Phone

Work Phone

*Emergency Contact

*Emergency Contact Phone Number

*Volunteer hours you are able to provide?

Waiver

I hereby grant permission to representatives of St. Philip's School & Community Center to provide care to my child in the event of injury or illness if I am not present. Such care may include but shall not be limited to first aid treatment, transporting to a medical facility, or the summoning of emergency assistance. I, the parent or appointed guardian of the above named child, hereby agree to indemnify and hold harmless St. Philip's School & Community Center and its officials, directors, managers, coaches and assistants from any liability for the above named child's activities of any nature with said organization.

*Waiver confirmation

I have read and agree with the waiver.

Refund Policy

The Policy

Registration fees are non refundable.

*Refund confirmation

I have read and understand the refund policy.

Statistics

How did you hear about this program?

Total Due:

$

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St. Philip's Saints

St. Philip's Saints

2024 Track Participant Registration Form