Student's Name: *
School Attends: *
Gender: *
Birthdate: *
Club Attending: Girls Running, Sports Club, Summer Track, Speed & Agility: *
Parent's Name *
Address: *
City, Zip: *
Home Phone: *
Cell Phone: *
Email: *
Emergency Contact: *
Emergency Contact #: *
2nd Sibling Name:
2nd Sibling Gender:
2nd Sibling Birthdate:
Uniform size top--Summer Track only
Uniform Size Bottom--Summer Track only
Waiver and Liability Fitness Statement: I hereby give Major Impact Sports and their staff to seek appropriate medical attention for our child in the event of an accident, injury or illness. I, the undersigned, will be responsible for any and all cost of medical attention and/or treatment. I hereby waive, release and forever discharge Major Impact Sports and their staff members from all rights and claims for damages, injury, loss to person or property which may be sustained during training, whether damages or loss is due to negligence. I hereby acknowledge that our child or children is/are physically fit and mentally capable of participating in all workout activities. : *	Yes No