Athlete First & Last Name *

Age *

Date of Birth *

Gender *

Female
Male

Custom Name on Shirt *

Please List Any Allergies,Illnesses, or Inhaler Requirements for Athlete *

PARTICIPANT RELEASE OF LIABILITY *

RELEASE/WAIVER In consideration for being permitted to participate in this Program. I, on behalf of myself and/or my minor. HEREBY RELEASE, WAIVE AND DISCHARGE St.Charles Heat Track Club from any and all liability associated with or related to my or my minor’s participation in the Activities of this Program, and agree Not To Sue St.Charles Heat or any of its Organizers for any reason resulting from or associated with me or my minor’s participation in any program activities. The risk of injury from the activities involved in this program includes all claims for injuries, accidents, illnesses, and/or property loss. I, for myself and on behalf of my minor, hereby release, indemnify and hold harmless the St.Charles Heat and its coaches, officials, other participants, and applicable owners used to conduct the event, from any and all claims.
I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK, FULLY UNDERSTAND ITS TERMS AND CONDITIONS.

Parent First & Last Name *

Email Address *

Phone Number *