This is an information sheet just for the coach. This will help the coaches keep track of the athlete’s progress, direction, and help to provide the best experience possible for your athlete. Please print legibly.

Level of competition desired

Not at all All-Comers Meets only Youth Meets JR Olympics

As a parent, are you willing to carpool to meets?

 YES NO

Help out at practice?

 YES NO

If yes, do you have any experience in track and field; either in high school, college, or otherwise?

YES NO
Events you are familiar with?  

List any other sports participation (past or present).

  

Emergency Information Card

Athlete Name

  

Birthdate

  

Address

  

Home Phone

  

Include ZIP

  

e-mail

  

Mothers Name

  

Work phone

  

Fathers Name

  

Work phone

  
List health conditions (allergies or other physical conditions)      

In an emergency, when we cannot be contacted, the SCTC authorities have our permission to use their best judgment in the interest of our child's health and welfare. The SCTC assumes no financial responsibility. If emergency service involving medical action or treatment is required and the parent cannot be reached for consent, the parent hereby consents to the rendering of such emergency medical services for the above named student as shall be necessary in the opinion of the medical staff rendering the service.

Name of Medical Insurance:

  

Policy Number:

  

Signature and date of Parent or Guardian:

  
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