Feel free to complete your form online, print it out, and then bring it with you on the registration date, to

Riley Elementary School 5021 Orchard St.

Athlete Information

Last Name: First Name: Middle initial:
Address: City: ,NE Zip:
Telephone #:

Athlete's Date of Birth:

/ /


Male Female

Registration Fee:

Will Not Sell candy bars ($90.00):
Will Sell candy bars (120 bars - payment due at registration):
Head Coach:

Shirt Size

Short Size

Check the Box if you wish to Help:

Work at the Little Green Classic:
Help at Practice:

Names of Parents or Guardians:

Father: Wk. Phone:
Father Email:
Mother: Wk. Phone:
Mother Email:


In consideration of being allowed to participate with the South Lincoln Track Club for the purpose of learning the art of exercise, stretching, and running.  I hereby personally assume all my child's risk, foreseen and unforeseen, in connection with my child's participation and I release any coaches, instructor, agents, supervisors and/or the South Lincoln Track Club from any injury or damage which may befall my child while participating with the South Lincoln Track Club. I agree to save and hold harmless South Lincoln Track Club and it's agents from any claim by my family, estate, heirs or assigns arising from participation in the South Lincoln Track Club program. I further warrant that I am legally competent to sign this release, that I understand the terms herein and that I sign this release as my own free act. I assume my child's responsibility of physical fitness and he or she is capable to perform the physical activities in which he or she will participate as a member of the South Lincoln Track Club.

I certify that the above athlete has my permission to compete in the South Lincoln Track Club and to Participate in the fund raising project.  I hereby accept full responsibility for this participation.

Signature of Parent or Guardian:_____________________________ Date: ___/___/____