Team Sports Center X-C Track & Field Academy

2010 Team Sports Center TC Registration form

^{Payment is due in full with registration}

^{Method of Payment:               Visa                     Master Card                       Check/Money Order                          Cash}

^{If paying by Credit Card:}

^{Card #:________________________________________ Exp Date:_________  3 digit Code ______}

^{Signature:__________________________________________________                                            Amount: _______________}

^{Contact Phone #:___________________                               Emergency Contact #: ________________________}

^{Students Name:________________________________     Address: _____________________________________________}

^{City: ________________________________   State: _________         Zip Code: _________________________}

^{Age: ___________________ DOB: __________________  Email: _____________________________________________}

^{Conditions of Attendance:  In consideration of the The Team Sports Center TC allowing my child to attend, I (we), individually and as legal guardian(s) (and/or) parent of: _____________________ (child’s Name) a minor, (“my child”),do hereby release, discharge, indemnify and hold harmless Triple Crown Sports, and its owners, directors, officers, employees, agents, successors and assigns from and against, and waive any and all claims or liabilities for any injuries, losses or damages, including without limitations, injuries to my child, my self and/or property arising out of incident to my child’s participation in Team Sports Center TC  to act for me according to their best judgment in any medical emergency for my child.}

^{Date: ________  201_______}

^{_____________________________________                                      _________________________________________}

                                ^{Witness                                                                                                                   Parent’s Legal signature}

^{Refund Policy: for cancellation or no shows – all payments are non refundable.  Credit will be given towards upcoming programs or services provided by Triple Crown Sports.}

^{Important Medical Information:  Due to rising insurance costs and our effort to keep our tuition reasonable, all children must be covered by their own medical benefits for any injury or sickness incurred while attending the Sports Center Inc Ultimate Athlete.  Please complete the following:} 

Insurance Carriers Name:_______________________________          Policy # _________________________________