ROCKY MOUNTAIN FLYING PANTHERS TRACK CLUB, INC.
WINTER INDOOR PROGRAM CLUB FORM
1731 Broadview Drive, Billings, Mt 59105
406 861 4157
ADDRESS: CITY: ZIP
USATF MEMBERSHIP # EXPIRES: SCHOOL: GRADE:
SIZE: XS S MED LG XL ADULT/YOUTH: (CIRCLE)
Make CASHIER CHECK or MONEY ORDER to R.M.F.P. / For CREDIT CARD (CC) use PAYPAL
PAYMENT: FOR 1st ATHLETE $295.00
PAYMENT: FOR PLUS 1 or MORE ATHLETES $185.00
I hereby authorize the coaches of the Rocky Mountain Flying Panthers Track Club, Inc to act for me according to their best judgement, in any emergency requiring medical attention. I hereby waive and release the Rocky Mountain Flying Panthers Track Club, Inc and the Rocky Mountain College. I know of no mental or physical problems which might effect my child's ability to safely participate in this track program. I will be responsible for any medical or other charges in connection with his or her attendance in this track program.
LIST ALL ALLERGIES and MEDICATIONS: .
SIGNATURE of PARENT/GUARDIAN DATE:
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