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Track Team Consent Form


Hixson Middle School Track Program



Informed Consent Form


I hereby give permission for __________________________ to participate on the

Track Team at Hixson Middle School for the 2013-2014 school year.

A fee of $25.00 is expected for this sport.

(Please Print)



Student’s Full Name   _____________________________________________________


Parent or Guardian      _____________________________________________________


Address _______________________________                   DOB   __________________


Phone No.       ___________________________________________________


Cell No.           ___________________________________________________


Alternative Number    _____________________________________________


Other person to contact in case of an emergency

Name   _____________________________________________      Relation __________


Phone  ______________________________________________


Cell      ______________________________________________


Family Physician ______________________________________    Phone  ____________


Medical conditions (e.g., allergies, chronic illness) ______________________________





We understand that each athlete must be a positive representative of Hixson Middle School. He/she must uphold our school’s reputation, exhibiting strong spirit and good sportsmanship at all games. Members not adhering to the above conditions will be removed from the team.


We understand this informed consent form and agree to its conditions.


Child’s Signature        ______________________________            Date    ___________


Parent’s/ Guardian’s   _______________________________          Date    ___________           Signature