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Member Information

First Name *

Last Name *

Gender *

Male Female

Date of Birth (YYYY *-MM-DD)

/ /

Athlete's email (if any) Opt in to emails

Athlete's cell number (if any) - International Number

School Name

Track Interest

Contact Information

Full Mailing Address - Street Address *

Address 2

City *

Province/Territory/State *

Country *

Postal Code *

Parent/Guardian Information

Parent/Guardian Name #1

Parent/Guardian Cell #1 - International Number

Parent/Guardian Email #1

Parent/Guardian Name #2

Parent/Guardian Cell #2 - International Number

Parent/Guardian Email #2

Emergency Contact Information

Emergency Contact Name *

Emergency Contact Relationship *

Emergency Contact Email *

Emergency Contact Phone * - International Number

Allergies or health concerns

Membership type

Membership type *

Category *

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Waivers

Photo Waiver - I, grant to Athletics Niagara, permission to use images of my child(ren) photographed in the track and field season for purposes of displays, media, website and other purposes in relation to the promotion of Athletics Niagara. I also give consent for the free use of names and/or pictures/video in any broadcast, telecast or website use. *

Club Waiver

In consideration of accepting membership in the Athletics Niagara (AN) Club, I nearby waive my rights and claims to damages against the Athletics Niagara (AN) Club, the Executive, Coaches, Representatives, Successors and Assigns for all and any injury that I may suffer during training to and from, or attending any track and field competitions. I have read and understand and agree to the terms of the application.

I have read and agree to the above *

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