Quicksilver Track Club Inc. P.O. Box 11169 Atlanta, GA. 30310	For club use only NEW   RENEWAL DOB Verified?   Y   N Age Group _________ Date ___/___/______ USA# ______________ Check# ____________ Chk Amt $__________
ATHLETE REGISTRATION & PARENTAL CONSENT FORM

ATHLETE INFORMATION

Name:                                                                                                 

Birthdate: _____/_____/_______            Age:                                         Boy [ ]  Girl [ ]

School:                                                                            Grade:                                            

Address:                                                                                                                                  

                                   (STREET)                                               CITY                             ZIP

Athlete’s Email:                                                               Home#:                                                 

T-Shirt Size:     YS        YM       YL        AS        AM       AL        AXL      AXXL

Uniform Size:   YS        YM       YL        AS        AM       AL        AXL      AXXL

PARENT INFORMATION

Parent/Guardian #1 Name:                                                          PHONE:                               

Email Address:                                                                                                                        

Parent/Guardian #2 Name:                                                          PHONE:                               

Email Address:                                                                                                                        

EMERGENCY INFORMATION

PERSON TO NOTIFY IN CASE OF EMERGENCY OTHER THAN PARENT

NAME:                                                                               PHONE:                                          

RELATIONSHIP:                                                                WORK:                                           

DO NOT FORGET A BIRTH CERTIFICATE, YOU CANNOT PARTICIPATE WITHOUT ONE!!