NEW ATHLETE REGISTRATION

Please note that the prices are the registration cost for the entire season.

Please obtain a USATF number for your athlete prior to completing team registration.

You can register your athlete with USATF here.

Uniform packages can be purchased through the team store.

The uniform is only required if your athlete will be participating in meets.

Meet entrance fees are not included in the price and are usually around $8-10.00 per person.

Payment can be submitted in one of three ways: 1. Online via PayPal or credit card

2. By check made out to "KT Express" on the first day of practice

3. By cash on the first day of practice.

If you are registering more than 3 athletes, please send an email to for information on how to register.

Athlete 1 Name

Athlete 1 Age

USATF Number

Athlete 1 School

Date of Birth

Gender

Medical & Insurance Information

Doctor's Name

Phone Number

Practice Address

Insurance Carrier

Insurance ID Number

Does this athlete have any allergies?

Yes

If Yes, Please List:

Does this athlete take any medications?

Yes

If Yes, Please List:

Has this athlete ever been hospitalized?

Yes

If Yes, Please Provide Reason and Date:

Has this athlete or any member of their family had any of the following?

Hypertension

Concussion

Down Syndrome

Kidney Disease/UTI

Mental Health Condition

Spina Bifida

Heatstroke

Excessive Bleeding

Food Allergies

Hemophilia

Phlebitis

Asthma

HIV

Fainting Spells

Heart Disease

Diabetes

Heart Murmur

Sickle Cell

Chronic Headaches

Epilepsy

Skin Problems

Heatstroke

Autoimmune Disorder

Herpes

Please list any other concerns we should be aware of:

Please be advised that if your child has a severe or life threatening illness, allergy or disability, you are required to stay at practice and meets with your child.

Athlete #2 Registration Information

Athlete 2 Name

Athlete 2 Age

USATF Number

Athlete 2 School

Date of Birth

Gender

Medical & Insurance Information

Doctor's Name

Phone Number

Practice Address

Insurance Carrier

Insurance ID Number

Does this athlete have any allergies?

Yes

If Yes, Please List:

Does this athlete take any medications?

Yes

If Yes, Please Provide Reason and Date:

Has this athlete ever been hospitalized?

Yes

Has this athlete or any member of their family had any of the following?

Hypertension

Concussion

Down Syndrome

Kidney Disease/UTI

Mental Health Condition

Spina Bifida

Heatstroke

Excessive Bleeding

Food Allergies

Hemophilia

Phlebitis

Asthma

HIV

Fainting Spells

Heart Disease

Diabetes

Heart Murmur

Sickle Cell

Chronic Headaches

Epilepsy

Skin Problems

Heatstroke

Autoimmune Disorder

Herpes

Please list any other concerns we should be aware of:

Athlete #3 Registration Information

Athlete 3 Name

Athlete 3 Age

USATF Number

Athlete 2 School

Date of Birth

Gender

Medical & Insurance Information

Doctor's Name

Phone Number

Practice Address

Insurance Carrier

Insurance ID Number

Does this athlete have any allergies?

Yes

If Yes, Please List:

Does this athlete take any medications?

Yes

Has this athlete ever been hospitalized?

Yes

If Yes, Please Provide Reason and Date:

Has this athlete or any member of their family had any of the following?

Hypertension

Concussion

Down Syndrome

Kidney Disease/UTI

Mental Health Condition

Spina Bifida

HIV

Fainting Spells

Heart Disease

Diabetes

Heart Murmur

Sickle Cell

Heatstroke

Excessive Bleeding

Food Allergies

Hemophilia

Phlebitis

Asthma

Chronic Headaches

Epilepsy

Skin Problems

Heatstroke

Autoimmune Disorder

Herpes

Please list any other concerns we should be aware of:

MEDIA RELEASE

KATY EXPRESS TRACK CLUB is proud to feature our athletes for the community to enjoy. With your permission, we would like to be able to publish your child's first name, last name, participating event, and photograph on our website.

Please indicate your preference by checking the appropriate spaces below:

I understand that the purpose of sharing this information electronically is to inform the community of the progress of the athletes.

I give my permission for the following information to be displayed on the KATY EXPRESS TRACK CLUB website, Instagram, Twitter, and/or Facebook accounts:

Child's First Name

Child's Last Name

Still Photographs of Child

Videos of Child

Child's Race Results

None of the Above

FORM SUBMISSION

By submitting this form, I hereby certify the following:

1. I am the Parent or Guardian of the above named applicant and the information is true to the best of my knowledge.

2. I also acknowledge the reserved rights of the KATY EXPRESS TRACK CLUB and understand that the KATY EXPRESS TRACK CLUB does not provide medical coverage.

3. I give permission for the above-listed child to participate in the KATY EXPRESS TRACK CLUB Track and Field/Cross Country/Indoor Track Program. I further release the coaching staff and the KATY EXPRESS TRACK CLUB from any responsibility for bodily injury my child may receive while participating in the program.

4. I understand that I am responsible for any medical fees accrued by my child as a result of medical attention.

5. I also grant permission to the KATY EXPRESS TRACK CLUB's president or his/her designee to complete all membership forms and registration materials required by the USA Track and Field Association and Amateur Athletic Union for participation in local and national meets.

I ACKNOWLEDGE I HAVE READ AND AGREE TO BE BOUND BY ALL OF THE ABOVE, INCLUDING THE CODES OF CONDUCT.View Codes of Conduct

Parent/Guardian Information

Relationship to Athlete(s)

From the Station to the Nation!

Est. 2016

NEW ATHLETE REGISTRATION

Medical & Insurance Information

Please be advised that if your child has a severe or life threatening illness, allergy or disability, you are required to stay at practice and meets with your child.

Athlete #2 Registration Information

Medical & Insurance Information

Athlete #3 Registration Information

Medical & Insurance Information

MEDIA RELEASE

FORM SUBMISSION

Parent/Guardian Information

Questions, Comments, Concerns?