Please fill out the registration, medical history, and waiver form sections below. You can register more than one child at a time through this registration form. In order for registration to be complete, you must submit payment.
Athletes and parents: This health record is a critical element in the determination of an athlete’s risk of injury in sports. Please take the time to read and answer all questions before submitting
your registration form.
1. Has anyone in the athlete’s family died suddenly before age 50?
2. Has the athlete ever stopped exercising because of dizziness or passed out during exercise?
3. Does the athlete have asthma (wheezing), hay fever, or coughing spells after exercise?
4. Has the athlete ever had a broken bone, had to wear a cast, or had an injury to any joint?
5. Has the athlete ever suffered a heat-related illness (heat stroke)?
6. Does the athlete have a chronic illness or see a doctor regularly for any particular problem?
7. Is the athlete allergic to any medications or bee stings?
8. Has the athlete had an injury/surgery/or been hospitalized within the last year that caused them to sit out from participating in any physical activity?
9. Please list any medications (allergy, asthma, etc.) that your child currently takes:
I/We as an individual or parent or guardian of the participant(s) named herein, assume all risks and hazards incidental to the activity, and release from responsibility and agree to indemnify and hold harmless 2nd Recess, the San Diego Track Club (SDTC), and their officers, directors, independent contractors, volunteers, sponsors and all employees for any illness or injury to me, my children, or family members, occurring during his/her/our participation in any activity or use of a recreational facility at or conducted by 2nd Recess and the SDTC.
I authorize the SDTC and 2nd Recess to use and reproduce any photographs, personal narrative, interviews, or audio and video recording of my child’s participation for any and all purposes.
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