Insurance Information

Medical Information:

I acknowledge that a physician has examined the registered athlete, within one (1) year of participation in Willingboro Track Club training and competition seasons. Furthermore, I acknowledge that said physician has certified that said athlete has been cleared to participate and complete in the various athletic activities related to track and field participation, contests, and competitions. Furthermore, I do hereby give my consent for the above athlete to participate in The Willingboro Track Club Program. I THE UNDERSIGNED HEREBY WAIVE AND RELEASE any and all claims I may have against Willingboro Track Club, Inc. IT'S OFFICERS, DIRECTORS, EMPLOYEES, COACHES, AND AGENTS OR ITS REPRESENTATIVES FROM ANY AND ALL LIABILITY DUE TO PERSONAL INJURY RESULTING FROM ACTIVITIES SPONSORED BY WILLINGBORO TRACK CLUB, INC. OR FOR WHICH WILLINGBORO TRACK CLUB, IS A PARTICIPANT. Moreover, I authorize the coaching staff or assigned chaperones of WILLINGBORO TRACK CLUB to act as Spokesperson in granting permission for emergency Treatment/Hospitalization (including Anesthesia), if necessary for the aforementioned athlete and to make any decisions concerning the health, welfare and safety including medical treatment of this athlete during my absence. I understand that should a Health Emergency arise, I will be notified, but if I cannot be reached by telephone, such medical treatment as deemed necessary by competent medical personnel is authorized.

Parent/Legal Guardian Consent & Release Form:

I am the parent/legal guardian of the above athlete. By my attestation, I hereby give my consent for the above named child to participate in practices, track meets, road races, travel and other activities sanctioned, sponsored, and/or attended by Willingboro Track Club (WTC). I authorize the Head Coach, Coaches or Staff members to sign the standard athlete’s release forms, USA Track & Field (USATF) and AAU (Amateur Athletic Union) documents when entering my child in any sanctioned events.

Should I (or my child) decide to withdraw from participation with Willingboro Track Club and its activities, I agree to notify WTC in writing, that I am withdrawing the above named child and acknowledge that all REGISTRATION FEES PAID ARE NON-REFUNDABLE and will only be applied to the 2025-26 (winter) season.

Further, in consideration of my child being a member of Willingboro Track Club, I hereby indemnify and hold harmless Willingboro Track Club, Board of Directors, WTC Head Coach, WTC Coaches, WTC Staff, WTC assigned Chaperones and assigned Chaperones against any and all rights and claims which I have or which may arise in conjunction with my participation or travel to and from practices, track meets, road races or other activities sanctioned, sponsored and/or attended by the Willingboro Track Club, USATF and AAU.

The attestation below represents that the above named child’s medical history including allergies, medications being taken and physical impairments that will in any way effect the child’s participation have been brought to the attention of The Willingboro Track Club in writing on the Medical Acknowledgement Waiver Consent and Release form of The Willingboro Track Club.

I understand my child will be covered by my personal medical insurance policy (provided herein) or, if not; I will cover the expenses of any injury.

By my attestation, I represent that I am the person that I purport to be and in the case of parent or legal guardian that such a relationship exist between the child and myself. By my attestation, also, I have read and agree to all RULES and GUIDELINES in the WTC Parent/Athlete Information Booklet/Handbook.

Photo/Media Release:

By attesting below, I, understand and agree that Willingboro Track Club has my permission to take and use my child’s track and field/club photographs, digital images, and video images for official club purposes such as, but not limited to media press releases, the club newsletter and all WTC social media accounts. Furthermore, I understand that by attesting the below I consent to the organization’s right to publish photographs depicting the minor athlete/child named above engaged in track and field events of Willingboro Track Club, whether as an active participant or as an observer, on the official Willingboro Track Club Website, Facebook, and Instagram page. I have fully read and considered all of the terms and statements contained in this release before attesting my agreement.