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2025 Carolina Blaze Registration

This form will need to be completed for each participating athlete.

Athlete Information

Athlete First Name

Athlete Last Name

When is 's birthday?

When is graduating from High School?

Has participated in track and field before?

Shirts/tops sizing

What is 's shirt size?

Shorts/Bottoms sizing

What is 's shorts size?

Parent(s)/Guardian(s) Information

Primary Contact First Name

Primary Contact Last Name

Primary Contact Phone Number

Primary Contact Email

Primary Contact Parent/Guardian Address

Primary Contact Address

Primary Contact Address Line 2

Primary Contact City/Town

Primary Contact State/Region/Province

Primary Contact Zip Code

Primary Contact Relationship to

Additional Parent/Guardian Information

This is not required. This section can be skipped if no additional parent/guardian contact information.

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Phone Number

Parent/Guardian Email

Additional Parent/Guardian Address

Additional Parent/Guardian Address is the same as the Primary Contact Address

Additional Parent/Guardian Address

Additional Parent/Guardian Address Line 2

Additional Parent/Guardian City/Town

Additional Parent/Guardian State/Region/Province

Additional Parent/Guardian Zip Code

Additional Parent/Guardian Relationship to

Emergency Contact Information For

Emergency Contact First Name

Emergency Contact Last Name

Emergency Contact Phone Number

Emergency Contact Email

Emergency Contact Relationship to

Medical Release Information For

The purpose of this information is to ensure that medical personnel have details of any medical problems which may interfere with or alter treatment.

Primary Physician First Name

Primary Physician Last Name

Primary Physician Phone Number

Primary Physician Email

What is your hospital preference?

Please list any medical problems, including any requiring maintenance medication

Is presently being treated for an injury or sickness, or taking any form of medication for any reason?

If yes, please explain

Is allergic to any type of food, beverage, or medication?

If yes, please explain

Does require a special diet?

If yes, please explain

I understand that I will be notified in the case of a medical emergency involving my child. In the event that I cannot be reached, I authorize the calling of a doctor and the providing of necessary medical services in the event my child is injured or becomes ill.

Signature

I understand that The Carolina Blaze will not be responsible for the medical expenses incurred, but that such expenses will be my responsibility as parent/guardian.

Signature

Additional Important Agreements

Risk

By its nature, competitive athletics may put children in situations in which serious, catastrophic, and perhaps fatal accidents may occur. Many forms of athletic competition result in violent physical contact among players, the use of equipment which may result in accidents, strenuous physical exercise, and numerous other exposures to risk of injury. Students and parents must assess the risks involved in such participation and make their choice to participate in spite of those risks. No amount of instruction, precaution, or supervision will totally eliminate all risk of injury. Athletic participation may be inherently dangerous. There have been accidents resulting in death, paraplegia, quadriplegia, and other very serious permanent physical impairment as a result of athletic competition. By granting permission for your child to participate in athletic competition, you, the parent/guardian, acknowledge that such a risk exists. By choosing to participate, you, the student, acknowledge that such a risk exists.

As the parent/guardian, you agree to hold harmless and release Carolina Blaze Youth Development and each of their respective affiliates, officers, directors, coaches, or representatives from any and all liability for all claims, demands, losses, damages and costs, including reasonable attorneys’ fees, that arise out of or in connection with any personal injury, property damage, and/or loss suffered by the child and or youth athlete in connection with his/her participation. Students will be instructed in the proper techniques to be used in athletic competition and in the proper utilization of all equipment worn or used in practice and competition. Students must adhere to that instruction and utilization and must refrain from improper uses and techniques. As previously stated, no amount of instruction, precaution, and supervision will totally eliminate all risk of serious, catastrophic, or even fatal injury. If any of the foregoing is not completely understood, please contact your school principal, athletic director, coach or athletic trainer for further information

Signature

Photo Release

I hereby give permission for my child to be photographed during The Carolina Blaze. I understand the photos will be used to keep a journal of activities, to share during power point presentations and/or reports to our donors and for promotional purposes including flyers, brochures, newspaper and on the internet. I understand that although my child’s photograph may be used for advertising, his or her identity will not be disclosed, I do not expect compensation and that all photos are the property of The Carolina Blaze.

Signature

Transportation Release

I hereby give permission for the transportation of my child for official Carolina Blaze activities by modes of transportation agreed to by coaching staff.

Signature

Lost/Damaged Property and Refunds

The Carolina Blaze Youth Development is not responsible for lost or damaged personal property. All scheduled events are subject to change. I understand that no fees will be refunded or transferred unless as noted above. Children's’ photos and quotes may be used for publicity purposes. In case of an emergency, and if a family physician cannot be reached, I hereby authorize my child to be treated by Certified Emergency Personnel (i.e., EMT, First Responder, and/or Physician).

Signature

Deposit Payment ($175)

The total cost for the season for athletes 14U and under is $475 (includes uniform, warm up sweatsuit, meet entry fees, and the AAU registration card.) The first practice for these athletes is March 17, 2025. The deposit is $175 with additional payments due on April 1, 2025 ($100); May 1, 2025 ($100); and June 1, 2025 ($100).

The total cost for the season for athletes 15U to 2025 High School Graduates is $300 (includes uniform, warm up sweatsuit, meet entry fees, and the AAU registration card). The first practice for these athletes is May 5, 2025. The deposit is $175 with additional payments due on June 1, 2025 ($125).