Participant's name *

Participant's age (as of Dec 31, 2025) *

What would you like your child to accomplish by the end of this 8-week program?

Medical Information: Please list any current medications, medical conditions, health concerns, past injuries, allergies, asthma, surgeries, or other important information our coaches should know about your child. *

Please enter your child's Pediatrician's name and phone number *

Media Release: I grant permission for Track State to use photos or video of my child participating in program activities for promotional materials, website, or social media.

Yes, I give permission
No, I do not give persmission

Participant Waiver & Release of Liability: I, the undersigned parent or legal guardian of the Program Participant, hereby acknowledge that participation in physical training activities such as sprinting, agility drills, and competitive games involves risk of injury. I voluntarily assume all risks associated with my child’s participation in Track State, whether known or unknown. I agree to release, indemnify, and hold harmless Track State, its coaches, staff, volunteers, and any associated facilities from any and all liability, claims, or causes of action, including those arising from negligence, that may occur while participating in this program. *

Refund Policy: I understand and acknowledge the following refund policy: • Full Refund: I am eligible for a full refund if I cancel my registration at least 3 days (72 hrs) before the program begins. • Partial Refund: If I cancel after the program starts but within the first week, I will receive a 50% refund. • No Refunds: I understand that no refunds will be issued after the first week of the program. I agree to submit any refund requests in writing to sandra.halvatzis@gmail.com. I understand that refunds may take up to 5–7 business days to process. *

Authorization and Acknowledgement: I certify that my child is physically able to participate in speed and agility training. I acknowledge that I have disclosed all known medical conditions and medications above. In the case that it is needed and if I cannot be reached, I authorize Track State personnel to seek emergency medical treatment for my child in case of injury or illness, and I accept responsibility for any medical expenses incurred. At their discretion, Track State personnel will reach out to my child’s doctor or will take my child to the closest emergency facility. *

Parent/Guardian Signature *

Parent/Guardian Email *

Parent/Guardian Cel Phone # *

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We appreciate you contacting us. One of our colleagues will get back in touch with you soon!

Have a great day!

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