ROCKY MOUNTAIN FLYING PANTHERS SIGN UP FORM
ROCKY MOUNTAIN FLYING PANTHERS TRACK CLUB, INC. SUMMER TRACK CAMP1731 Broadview Drive, Billings, Mt 59105406 861 4157NAME: BIRTHDAY: ADDRESS: CITY: ZIP AAU # SCHOOL: GRADE: $350 cash or money order Make CASHIER CHECK or MONEY ORDER to R.M.F.P. / For CREDIT CARD (CC) use PAYPAL PAYMENT: FOR 1st ATHLETE ( $350.00 PAYMENT: FOR PLUS 1 or MORE ATHLETES $275.00MEDICAL RELEASE: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: PRINT NAME EMAIL: PHONE NUMBER
