Medical Office Registration Form s8

DLA A0 TRACK 2017 REGISTRATION FORM

ATHLETE INFORMATION Athlete’s last name: First: Middle: Sex: Birth date:

Street address: Home phone no.: ( ) P.O. box: City: Province: Postal Code:

Parent’s Name: Parent’s Email Address: Parent’s Phone Number: ( ) Do you have any siblings registered with DLA? If so, please note their name here: PLEASE ATTACH A COPY OF THE ATHLETE’S BIRTH CERTIFICATE WITH THE APPLICATION

Athlete Category Year of Birth Team Fee** Payment Due Dates

Oct 2016 $150, Nov 2016 $150 $800 = Payment Dates Jan 2017 $100, Feb 2017 $100 Athletics Ontario (AO) 2004 or later $770 = Payment in Full Feb 2017 $150, April 2017 $150

Athletics Ontario (AO) Only Indoor or Outdoor Season 2004 or later $450 = Payment in Full N/A only

PAYMENT: CERTIFIED CHEQUES OR MONEY ORDER PAYABLE TO DURHAM LEGION ATHLETICS. $25 ADMINISTRATION FEE PLUS BANK CHARGES FOR INSUFFICIENT FUNDS CHEQUES.

** Basic Team Fees cover Ontario Track and Field meets only**. All Athletes are required to cover the cost of their travel expenses (meals, hotel & transport).

I agree to pay DLA in full and understand that non-payment will result in my child not being able to participate from DLA practices and Track meets. I understand that I am responsible for all costs related to the athlete’s travel to and from all track meets.

Patient/Guardian signature Date DLA TRACK 2017 WAIVER FORM

In consideration of accepting this membership application, to Durham Legion Athletics (DLA), I hereby for myself, my heirs, executors and administrators, waive and release all claims for damage that I may have against the DURHAM LEGION ATHLETICS, its agents, successors, representatives and assigns for any and all injuries of accidents suffered by me and/or members of my family named above, which may arise out of travelling to, participating in or returning from any training practice, athletic meet of activity of the DURHAM LEGION ATHLETICS.

______Signature of Applicant Date

______Signature of Parent/Guardian Date

Note: A signed waiver form allows coaches to sign meet waiver forms for athletes. If you do not wish to sign this form, it will be necessary for you to sign each and every meet waiver prior to registering your child for a meet.