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TRACK AND FIELD ASSOCIATION OF CAPE BRETON
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Contact Info
Name
*
First Name
Last Name
Gender (M/F)
*
Date of Birth
*
MM
DD
YYYY
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Parent/Guardian
Events Interested In
Email Address
*
Phone
*
(###)
###
####
Medical Information
Doctor's Name
First Name
Last Name
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
(###)
###
####
Allergies
Medical Conditions
*
I give my irrevocable consent and permission to Track and Field Association of Cape Breton (TFACB), to take photographs and/or videos, for publication, advertising, promotional purposes of any kind, without payment of additional compensation. I understand, acknowledge, and agree that any such photographs and/or videos can be used for TFACB’s related publication, advertising, advertisements, fact sheets, brochures, web sites, internal communication system, poster boards, program booklets and other print material produced by TFACB.
I do give consent
I do not give consent
Emergency Contact
Name
First Name
Last Name
Relationship to Participant
Phone
*
(###)
###
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Informed Consent
*
I recognize that this activity has natural inherent hazards and allow my child to participate.
Additional Comments
Thank you!