2008 Registration Form
Asheville Lightning Junior Olympics Team

Amount Received________ Cash___ or Check #______
Membership: Regular ($125)___ Family Discount ($100)___
Practice Only ($100)___

PLEASE PRINT

PARENT/GUARDIAN NAME: First______________________Last____________________

PARENT EMAIL: ____________________________________________________________
                                                        PRINT CLEARLY

ATHLETE NAME: First_______________ Last____________________SHOE SIZE:_______

DATE OF BIRTH:______________________AGE:________________SEX: M_____F_____

SCHOOL______________________________LAST GRADE COMPLETED_____________

ATHLETE EMAIL:___________________________________________________________

ATHLETE'S ADDRESS: Street__________________________________________________

                                                   __________________________________________________

                                          City_________________________State__________Zip_________

HOME TELEPHONE:_____-_____________WORK TELEPHONE____-_______________

PARENT CELL PHONE:_____-____________  ATHLETE CELL:_____________________

EMERGENCY CONTACT:__________________________TELEPHONE____-___________ 

MEDICAL INFORMATION WAVIER 

I know that running and volunteering to run in team races are potentially hazardous activities. I should not enter and run in team activities and sports unless I am medically able and properly trained. I assume all risks associated with running and volunteering to work in team races including but not limited to falls, contact with other participants, the effects of weather, including extreme heat, cold or humidity, the condition of the track and/or courses, all such risks being known and appreciated by me and by my parent/guardian. Having read this waiver and knowing these facts, and in consideration of your acceptance of my application for membership, I, for myself and anyone entitled to act on my behalf, waive and release the Asheville Lightning Junior Olympic Team and all coaches, sponsors and their successors from all claims or liabilities of any kind arising out of my participation in these club/team activities even through that liability may arise out of negligence or carelessness on the part of the persons named in this waiver. 

BOTH ATHLETE AND PARENT/GUARDIAN MUST SIGN BELOW. THESE SIGNATURES PERTAIN TO THE MEDICAL INFORMATION WAIVER.

         ATHLETE:______________________________________PARENT/GUARDIAN____ญญญ_____________________________________

 

PLEASE LIST ANY MEDICAL CONDITION YOU HAVE THAT WE SHOULD KNOW ABOUT:

__________________________________________________________________________

LIST ANY ALLERGIES:____________________________________________________________________

DO YOU USE AN INHALER: Yes___ No___ (If yes, be sure and bring it to practice with you.)

NAME OF DOCTOR:_______________________________    TELEPHONE:_____-_________________

INSURANCE COMPANY:____________________________    POLICY #:_________________________

Membership Fees:

Regular Membership (Practices & Competitions): $125 and 5 copies of birth certificate required.
Family Discount: $125 for first two family members on team, $100 for all others family members
Practice Only Membership: $100

 

For Team Membership: Please include 5 copies of your birth certificate (not the original!) and the team membership fee of $125 (make checks payable to the Asheville Lightning) along with this Registration Form. The fee covers meet registration fees and team T-shirt. Members will also be required to purchase a team singlet top and running shorts before the State Meet if they qualify and plan to compete in that meet. This is an additional cost of $25.

For Practice Membership: Please include the Practice-Only membership fee of $100.  Copies of your birth certificate are not required for Practice Only membership.                

ATHLETE'S SIGNATURE:__________________________DATE:__________

PARENT/GUARDIAN SIGNATURE:_________________________________