Glencadia Bullets Registration Form
Email *
Athlete Name *
Athlete date of birth *
MM
/
DD
/
YYYY
Athlete's School
Athlete's Age *
Athlete's Grade *
Address *
Parent/Guardian Names *
Parent/Guardian Email *
Parent/Guardian Email 2
Parent/Guardian Phone Number 1 *
Parent/Guardian Phone Number 2
Athlete's current medical conditions, allergies, or medications. If none, write none *
Parent / Guardian agrees to:
Consent to Participate: I understand there are inherent risks for injury involved in participation in the sport of track and field and road
racing. I hereby assume such risks for the athlete during his/her athletic participation in, and travel to and from, track and field meets,
road races, and or practices and hereby consent to his/her participation and said travel.

READ BEFORE SIGNING
IN CONSIDERATION OF my child, being allowed to participate in any way with the Glencadia Bullets Track and Field Club, related events and activities, the undersigned acknowledges, appreciates, and agrees that:
The risks of injury and illness (ex: communicable diseases such as MRSA, influenza, and COVID-19) to my child from the activities involved
in these programs are significant, including the potential for permanent disability and death, and while particular rules, equipment, and personal
discipline may reduce these risks, the risks of serious Injury and illness do exist; and,
FOR MYSELF, SPOUSE, AND CHILD, I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and
unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASES or others, and assume full responsibility for
my child's participation; and,
I willingly agree to comply with the program's stated and customary terms and conditions for participation. If I observe any
unusual significant concern in my child's readiness for participation and/or in the program itself, I will remove my child from the
participation and bring such attention of the nearest official immediately; and,
I myself, my spouse, my child, and on behalf of my/our heirs, assigns, personal representatives and next of kin, HEREBY
RELEASE AND HOLD HARMLESS The Glencadia Bullets Track and Field Club and the Glencadia Rod and Gun Club; its
coaches, directors, officers, officials, agents, employees, volunteers, other participants, sponsoring agencies, sponsors,
advertisers, and if applicable, owners and lessors of premises used to conduct the event ("Releasees"), WITH RESPECT TO
ANY AND ALL INJURY, ILLNESS, DISABILITY, DEATH, or loss or damage to person or property incident to my child's involvement or participation in these programs, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law.
I, for myself, my spouse, my child, and on behalf of my/our heirs, assigns, personal representatives and next of kin, HEREBY
INDEMNIFY AND HOLD HARMLESS all the above Releasees from any and all liabilities incident to my involvement or participation in these programs, EVEN IF ARISING FROM THEIR NEGLIGENCE, to the fullest extent permitted by law.
I, the parent/guardian, assert that I have explained to my child/ward: the risks of the activity, his/her responsibilities for adhering
to the rules and regulations, and that my child/ward understands this agreement. FOR MYSELF, MY SPOUSE, AND CHILD/WARD, HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT WE HAVE GIVEN UP SUBSTANTIAL RIGHTS
BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
Your printed name will act as your signature on this form. Please write your name below.
 *
UNDERSTANDING OR RISK
I understand the seriousness of the risks involved in participating in this program, my personal
responsibilities for adhering to rules and regulation, and accept them as a participant. Your printed name will act as your signature on this form. Please write your name below.
 *
Medical Insurance: As I have agreed to assume the risk and responsibilities for any Injuries that may occur in connection with the
athlete's participation in, and travel to and from, track and field meets and road racing, I also affirm that I have medical insurance to cover
any such injury.
Athlete's Insurance Company is
 *
Insurance Policy/Member # *
In Case of Injury: I consent to allow the coach and or competent medical personnel to act as first respondent to administer initial first aid. I
do request however, (that if I am not at the site/event), the coach(s) first attempt to contact me prior to seeking any advanced medical
treatment.
Indemnity: Parent/guardian including athlete, agree to indemnify and hold harmless the Glencadia Bullets Track and Field Club and
coaches from all rights and claims for damages, which may occur with the athlete's participation in track and field meets, travel, road races
and practices. Your printed name will act as your signature on this form. Please write your name below.
 *
Parent Consent Form
I hereby give permission for my child
to travel with the Glencadia Bullets Track and Field Club for the 2025 Season. In the event my child becomes ill and/or injured and requires medical attention, all reasonable efforts will be made to contact me and obtain any required consent for medical care. In situations where I
cannot be reached, and such delay creates a risk to my child; the Glencadia Track and Field Club will use this form to obtain medical records to seek care and treatment for my child, and I hereby authorize my child's coach to act on
my child's behalf.
Your printed name will act as your signature on this form. Please write your name below.
 *
Emergency Phone Number *
Physician's Name *
Physician's Phone Number *
Code of Conduct
I agree to conduct myself in a courteous and
respectful manner at all times. I understand that I am representing the Glencadia Bullets Track and Field Club and
USATF and will respect others on and off the track. I understand that if I break this contract that it can result in my
removal or suspension from the team. I understand that participating with the Glencadia Bullets Track and Field
Club is a privilege rather than a right and I will not conduct myself in any manner that is inappropriate or
unbecoming to the Glencadia Bullets Track and Field Club.
TEAM GUIDELINES:
Support other team members in a positive fashion.
Coach's decision is the final decision.
No swearing or back talk to Coaches, Parents, or Officials.
Be considerate of all other team members.
No walking off of the track during the meet.
USATF is a smoke, drug and alcohol free association.
Obey team rules and curfews.
Good sportsmanship must be displayed at all times.
Be good citizens on and off the track. 
Your printed name will act as your signature on this form. 
Please write parent and athlete names below.
 *

PRACTICES
Practices are held every Monday at the Ichabod Crane High School Track and Thursday at Chatham High School Track from 6:00-7:30pm, from May through July. Often there are changes to this schedule, or practice may be shortened due to inclement weather. Parents are therefore asked to adhere to the following guidelines for practices:

– If your athlete is 12 years old or younger, please stay at the track during practice.

– If your athlete is 13 years old or older, they may be dropped off at practice, provided we have a cell phone number where we can reach you.

All parents are strongly encouraged to remain at the track for the entire length of each practice, though – in case of injury, emergency, or the sudden onset of inclement weather.

 

MEET FEES & PAYMENTS
The cost per season is $50 per athlete, which includes a uniform jersey and entry into select Empire State Sports Council meets throughout the season. Additional fees apply for USATF membership and meets. Generally meets are held on the weekends (either a Saturday or Sunday) throughout the months of May, June and early July. Guidelines for ALL meets:

– All Glencadia Bullets must wear their team issued uniform during meets. Often we have extra uniforms on hand if your athlete forgets theirs. Bibs will not be issued to any athlete who is not wearing their uniform.

– Some entry fees for Empire State Sports Council meets are covered by the Glencadia Rod & Gun Club as Team Sponsor. If your athlete signs up for a meet but then cannot compete (for any reason), you will be asked to reimburse the club for the cost of that registration.

 

SOCIAL MEDIA POLICY
Negativity in any form in our team environment or on social media – from athletes or parents/family members, etc. – will not be tolerated. Please monitor your child’s social media. Disparaging comments about our team, coaches, coordinators, or other athletes, on “personal” Facebook pages or other social media accounts – by athletes or their parents – will result in disciplinary procedures. Parents are responsible for their child’s social media presence, as well as their own, when it comes to comments about the team.

Our goal is a positive team environment. Thank you for helping us to maintain this positive atmosphere for all of our participants.

Your printed name will act as your signature on this form. Please write your name below.

 *
AGE DIVISIONS & ELIGIBILITY REQUIREMENTSAge Divisions                                                                                       

8 & under (born 2017+)


9 - 10 (born 2015-2016)


11 - 12 (born 2013--2014) 


13 - 14 (born 2011-2012) 


15 - 16 (born 2009-2010) 


17 - 18 (born 2007-2008)*
*athletes born in 2006 are also eligible if they do not turn 19 on or before 7/21/2025

*Per USATF Rule 300.1 (c) “Athletes must be at least seven (7) years of age on December 31 of the current year to compete at the Youth Athletics or Junior Olympic National Championships.

Your athlete's age division:

 *
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms