The registration form is available . You can also contact MariettaTrackClub@ gmail.com for a PDF version.
- On Thursday Stacey Lester will be at the top of the Kennesaw mountain High School track bleachers from 6:30 - 7:30 p.m. to accept registrations forms.
- Spring 2022 Track And Field practice begins Monday, January 13, 2022
- Spring 2022 Track And Field Early registration fee is $250.00 and covers uniforms, meet fees & t-shirt.
- After January 13, 2022 Fee $300.00
- Payment accepted as cash, check, or money order or
- cash app - ($mariettatrackclub1)
MARIETTA
TRACK CLUB
Athlete (s) Information
(PLEASE USE NAME ON Birth CERTIFICATE)
(#1) First Name: __________________________________
Last Name: ______________________________
Age: ______ Date of Birth: ______________ Gender M - F
Athlete Phone: ____________________
Youth-S________
YM_______ YL_______ YXL_________
Adult-S_______AM_______ AL______ AXL______AXXL_________
Home Address: ___________________________ City: ____________________
St: ____
Zip: ______________
Zip: ______________
(#2) First Name: __________________________ Last Name: _____________________________
Age: ________ Date of Birth: _______________ Gender: M F Athlete CELL: ________________
Youth-S____ M____ L____
XL____ YXL_____
Adult-S ______M______L_____XL________
Home Address: ____________________________ City: ____________________
St: ____
Zip: ____________
Zip: ____________
Parent/Guardian Information
First Name: ______________________________ Last Name: ________________________________
Relationship to Athlete: ______________________ Cell :
__________________________________
Email: ____________________________________________
First Name: _________________________________ Last Name: _____________________________
Relationship to Athlete: _______________________ Cell :
________________________________
Email: ______________________________________________________________________________
Emergency Contact
First Name: ______________________________ Last Name: ________________________________
Relationship to Athlete: _______________________ PHONE #
______________________________
First Name: ______________________________ Last Name: _______________________________
Relationship to Athlete: _______________________ PHONE # ______________________________
Medical Information
Primary Care Physician: _____________________________________________________________
Allergies:
_________________________________________________________________________
Current Medications: ________________________________________________________________
Please list any
medical conditions we should be aware of to help your child enjoy the sport.
__________________________________________________________________________________
To the best of my knowledge, there are no physical or other
conditions, which will interfere with my
Child’s participation. I certify that my child has had a
medical examination within the last 12 months and, in the physician’s opinion,
is physically capable of completing the sports or activities for which he/she has
registered for.
Signature______________________________________________________________________
Early Registration fee ($250.00)
per athlete for the 2022 SPRING Track Season (No Refund After 1st Day of Practice).
After January 13, 2022 Fee $300.00
After January 13, 2022 Fee $300.00
This fee covers the cost of the – Uniforms -T-Shirt, Meet Fees.
Payment Information Marietta Track accepts
Cash, Money Order,
Checks, ------- Made payable Marietta Track ClubCash App ($mariettatrackclub1)
http://mariettatrackclub.blogspot.com/ (Website)
*Additional required
documentation:
Please submit a copy of the athlete Birth
Certificate to - mariettatrackclub@gmail.com
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