Ultimook Youth Track Day Camp July 8-19

$40.00

Name of Participant*
First Middle Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Email
Participant Date of Birth*
Month
Day
Year
Grade entering in 2024*
Gender*
- Male
- Female
Club t-shirt Quantity
Price: $10.00
This is optional. If you want one please add quantity.
Shirt Size*
Is there anything we should share about your child with our coaches?
We take lots of photos of kids participating in practice. We may post these pictures on our Facebook/Instagram account advertising the club or potentially use in a future flyer. Please indicate here yes/no whether or not it is okay to use photos with your child in our marketing.*
- Yes
- No
Emergency contact name:
First Last
Emergency contact phone
Emergency contact email:
Parent Signature*

By typing your name here, you give permission for your son or daughter to participate in the Ultimook Youth Track Club
Date of Application*
MM slash DD slash YYYY