Membership Form

Indoor Membership Form

Athlete Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Primary Phone Number *

Date of Birth *

Email *

Gender *

2023-24 School Grade *

Name of 2023-24 School

T-Shirt Size *

Uniform Size *

Will you need to purchase a uniform? *

Have you previously participated in club track (other than LTC)? What club?

Parent/Guardian #1 *

First

Last

Email *

Home Phone

Work Phone

Cell Phone

Parent/Guardian #2 *

First

Last

Email *

Home Phone

Work Phone

Cell Phone

Emergency Contact *

First

Last

Phone *

Relationship to Athlete

Liability Waiver *

Agree

I agree not to hold any volunteer or member of the Louisville Track Club liable if the above mentioned Participant is injured while participating in any Louisville Track & Field Club activity. By my signature, and of my free will, I do hereby agree to indemnify and save harmless any volunteer or member of the Louisville Track Club from any and all claims or demands, cost or expense arising out of any injuries or damage sustained by any party I am responsible to or for, including the above mentioned Participant.

Signature

Select Fee

Acceptance will be determined once the registration window is complete.

Name