ROCKY MOUNTAIN FLYING PANTHERS TRACK CLUB INC.
4706 E. SLIGH AVENUE, TAMPA, FLORIDA 33610
813 868 9510 & 406 861 4157
ADDRESS:_______________________________________________________SIZE xs s m l xl xxl / Y/A
Make CASHIER CHECK or MONEY ORDER to R.M.F.P. / or CASH
For CREDIT CARD (see MEA)
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. I know of no mental or physical problems which might affect 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____________________________________________________
PRINT NAME _________________________________________________________________________
PHONE NUMBER _________________________EMAIL______________________________________