ELITE & NOVICE REGISTRATION FORM
 
Thank you for your interest in spring track and field.

Please take a moment to complete the form below and proceed to checkout. Have your debit or credit card handy.

Bergen County Xpress Track Club does not limit participation in its activities on the basis of disability, race, color, national origin, gender, or religious preference.


FAMILY CONTACT INFORMATION
E-Mail:*

Valid e-mail is required
2nd Optional E-Mail:

Valid e-mail is required
Relationship*

First Name:*

Last Name:*

Address Line 1:*

Address Line 2:

City:*

State:

Zip Code:*

Home Phone:*

EMERGENCY PHONE*

NUMBER TO REC. TXT MESSAGES*

2nd OPTIONAL NUMBER TO REC. TXT MESSAGES

 

ATHLETE 1 INFORMATION
First Name:*

Last Name:*

SELECT PROGRAM*

Date of Birth:*

MM/DD/YEAR
Gender:*
Boy Girl 

Relevant Medical Information

Allergies? Asthma?
Are there restrictions that prevent this athlete from training / competing on Saturdays or Sundays?*
YES NO 

 

ATHLETE 2 INFORMATION
First Name:

Last Name:

SELECT PROGRAM

Date of Birth

MM/DD/YEAR
Gender
BOY GIRL 

Relevant Medical Information

Allergies? Asthma?
Are there restrictions that prevent this athlete from training / competing on Saturdays or Sundays?
YES NO 

 

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