16WAYS Foundation | 16Ways Track

2022 Registration Form

REGISTRATION FORM
Please complete all fields of the registration form below. Required fields are denoted with an *.

PARENT/GUARDIANS - In addition to the registration form below, please print, sign and send us the required Parent/Guardian Permission Form. Download the form here!

Student Athlete Name

Date of Birth

Gender

Address

City, State, Zip

Parent/Guardian Name

Phone

Emergency Contact

Phone

Relationship

Alternate Emergency Contact

Phone

Relationship

Primary Care Physician

Phone

Address

Preferred Hospital

Allergies

Asthma?

Other Health Issues

Insurance Information

Events

AAU Membership Number

Please upload a copy of AAU Membership

Upload File

IMPORTANT NOTE: We will need backup inhalers, allergy medication, and any other medication the student athlete may need.

Thanks for submitting!