ROCKY MOUNTAIN FLYING PANTHERS TRACK CLUB INC. 4706 E. SLIGH AVENUE, TAMPA, FLORIDA 33610

813 868 9510 & 406 861 4157

NAME:​ __________________________________________________________BIRTHDAY_________  

ADDRESS:_______________________________________________________SIZE xs s m l xl xxl / Y/A  

CITY:_______________________________________STATE_____________________ZIP__________  

SCHOOL:____________________________________________________GRADE__________________  

Make CASHIER CHECK or MONEY ORDER to R.M.F.P. / or CASH For CREDIT CARD (see MEA)   1st Athlete    2nd Athlete    3rd Athlete  

MEDICAL 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. 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 _________________________________________________________________________  

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