PLEASE PRINT AND SEND TO ADDRESS BELOW:
ATHLET NAME (Last) _____________________________ (first) ______________________________
PARENT OR GUARDIAN (Last) _________________________ (first) ___________________________
ADDRESS ____________________________________________________________________________
CITY/STATE/ZIP ______________________________________________________________________
PHONE (home) ____________________________________ (other) _____________________________
BIRTHDAY (month/date/year) ____________________________________________________________
AGE (AS OF DEC. 31, 2008) ______________ MALE: _________ FEMALE: _______
EVENT(S) Please check what you think your child would be interested in:
100 Meter _____ 200 Meter _____400 Meter _____ 800 Meter ____ 1500 Meter ____
3000 Meter _____Long Jump _____ High Jump _____ Hurdles _____ Discus ____ Shot Put ____
1600 Meter _____ 3200 Meter ______ 5000 Meter ______ Pole Vault _____ Javelin _______
PLEASE CHECK WHERE APPLICABLE:
____My child will participate in USATF Junior Olympics Track and Field Fees: Given Separately
PLEASE NOTE: Please provided the following documents with the application. Failure to do may cause your child(ren) to be ineligible to participate in any of the Track and Field Meets.
Please provided the following documents with the application. Failure to do will cause your child(ren) not eligible to participate in Any of the Track and Field Meets:*APPICATION* APPROPRIATE APPLICATION FEES*COPIES OF YOUR CHILD'S BIRTH CERTIFICATE (NEW ATHLETES) * PHYSICAL FORM
Jaguar Track Club will always do everything possible to ensure the safety of all athletes. However we are not responsible for any injuries sustained during practice, travel, or during the course of any track meet. Also, signing this application will givethe Club Organizer your permission to sign all documents that will enter your child(ren) into track and field meets and trackand field meets only.
PHYSICAL FORM
Jaguar Track Club will always do everything possible to ensure the safety of all athletes. However we are not responsible for any injuries sustained during practice, travel, or during the course of any track meet. Also, signing this application will givethe Club Organizer your permission to sign all documents that will enter your child(ren) into track and field meets and trackand field meets only.
.
SIGNATURE (Parent or legal guardian)________________________________________
DATE: ______________________________________
PLEASE PRINT AND SEND TO:
Coach Curtis Jackson
2776 Jaguar Drive
Ellenwood, Georgia 30294
Website: www.jaguartrackclub.com
Email: jaguar9@bellsouth.net
404-241-3667
Please cut below for the club's Medical Form
MEDICAL FORM
2007
NAME OF SCHOOL __________________________________ YEAR _________________
I certify that I have examined ____________________________________ of this school and (do) (do not)recommend (him) competing in track and field contests. The following points were particularly checked and the condition noted as follows:
HEART:
Before exercises __________________ After
exercises ____________________ After brief
period __________________ Blood pressure
____________________ Murmurs
_________________________
LUNGS:
Is there a history of:
Chronic cough __________________
Sputum _________________________
Other conditions _________________
WEIGHT IN ITS RELATION TO HEIGHT:
Underweight ___________________________
Overweight _____________________________
Satisfactory ____________________________
GENERAL CONDITION:
Excellent ______________________________ Good
__________________________________ Fair
___________________________________ Below Par
_____________________________
FAMILY HISTORY: Any serious medical problems in the family? ____Yes ___ No ( If yes, please explain):
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
____________________
DATE: _____________ SIGNATURE OF PHYSICIAN _____________________________