Welcome to the team!!

Athlete's First name

Athlete's Last name

Athlete's Address

Athlete's Birthday

Month

Day

Year

Athlete's Current Age

Phone

Gender

Parent/Guardian Name

Parent/Guardian Address

(If different from athlete)

Parent/Guardian Address

(If different from athlete)

Parent/Guardian Phone

Parent/Guardian Email

Medical History/ Daily Medications

Physician Name/Telephone Number

Insurance Card Information

Permission to Give athlete Tylenol/Advil

Yes

Emergency Contact #1

(Name, phone number, relationship to athlete)

Emergency Contact #2

(Name, phone number, relationship to athlete)

I was introduced to the team by:

Have you ever participated in Track and Field?

Yes

If yes, what events have you competed?

Athlete's Signature

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Parent's Signature

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Today's Date

Month

Day

Year

FSD Photography Consent & Release form

In consideration of the participation of my child in the First State

Destroyers Track & Field Club, I, in my own right and as next friend of such minor child, for myself and for such minor child, our heirs, successors, administrators and assigns, hereby contractually waive, relinquish and

release any and all rights, claims, actions and/or causes of action we may have against the First State Destroyers, Founder Lansil Gordon, and/or any assistant coach, volunteer , or other club personnel for personal injury or property damage arising from, or in any way connected outside, the Destroyers Track & Field Club during the 2026 calendar year.

I further certify that the minor child named above is granted my permission to participate in the First State Destroyers Track & Field Program. I am aware of the intensity of the training and competition involved and the associated risks, and I certify that such a child is physically fit to participate in such a program. I further certify that I know of no physical condition or Impairment that would in any way prevent such a child from participating in the program.

The parent(s) or legal guardian(s) of this athlete have read the foregoing,

understand the same and do hereby accept and agree to the terms: conditions and provisions of the foregoing

Release Indemnity on behalf of ourselves and the said minor, intending to be legally bound hereby.

I hereby give my consent in this waiver, release, and statement of physical conditions.

I grant permission to the FIRST STATE DESTROYERS TRACK CLUB

AND ROSEHILL COMMUNITY CENTER, hereinafter known as the “Media” to use my/my child’s

image (photographs and/or videos) for use in Media publications

including:

● videos

● email blast

● recruiting brochures

● newsletters

● websites and/or affiliates

● General Publications

● social media (i.e. Facebook, Instagram, Twitter, band, etc.)

I hereby waive any right to inspect or approve the finished photographs or electronic matter that may be used in conjunction with them now or in the future, whether that use is known to me or unknown, and I waive any right to royalties or other compensation arising from or related to the use of the image.

I hereby give my consent to use my photographs according to the Terms & Conditions.

First name

Last name

Confirm with your initials

Welcome to the team!!

FSD Photography Consent & Release form

All athletes must be USATF members. This covers insurance and required for some meets. Please click here to switch to the site to register and pay.

The registration fee is $150. Meet fees are per meet.

When paying with card there is a processing fee of $17.50