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Member Information

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Last Name *

Gender *

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Date of Birth (YYYY *-MM-DD)

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Birth Country *

Parent/Guardian *

Parent/Guardian Email * Opt in to emails

Contact Information

Full Mailing Address - Street Address *

Address 2

City *

Province/Territory/State *

Country *

Postal Code *

Individual Email Opt in to emails

Phone * - International Number

Other Information

Singlet Size *

Guardian/Emergency contact #2 Name *

Guardian/Emergency contact #2 Email *

Guardian/Emergency contact #2 Phone *

School Attending

Grade Attending

Care Card Number

Family Physician *

Family Physician Phone

Health Problems (please note any health problem, physical handicap, emotional difficulty, behaviour problem, or other factors that may limit full participation in the Langley Mustangs) *

Medications (list any medications, prescription or over-the-counter, taken on a regular basics. Note dosages and medication scheduling)

Does your child require additional supports or accommodations? Please provide details. *

Membership type

Membership type *

Category *

Waivers

I have read and agree *
Sport Safety Acknowledgement of Risk

I have read and agree *
Langley Mustang Track and Field Athlete Contract

I have read and agree *
BC Athletics Membership requirement

2025 Langley Mustangs Sprints & Jumps JD program

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Other Information

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