Wall of Fame
Date of Birth
Primary Parent/Guardian Phone Number
Primary Parent/Guardian Electric Signature
Emergency Contact Name
Emergency Contact Phone Number
Relationship to the Athlete
Street Address (Please Include APT or SUITE Number In This Section)
What Selection Do You Wish To Partcipate In?
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Select An Uniform Size
What Year Do You Wish To Partcipate In?
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Do you allow Plainfield Tsunami Track Club to utilize your Student Athlete's name, image and likeness?
Select a Response
I recognize that in any athletic activity there is an inherent risk of injury. As parent/guardian, I assume full responsibility for the safety of my child and agree to hold harmless the Plainfield Tsunami Track Club, its officers and coaches for injury sustained by child during and meet, practice, or track activity. By my checking the box below, I acknowledge that I fully understand all of the provisions stated on this form.
I hereby give my permission for any and all medical attention necessary to be administered to my child (named above) in the event of an accident, injury, sickness, etc., under the direction of the program officials and the person (s) listed below, until such time as I can be contacted. This release is effective until December 31, 2023.
We, the athletes/parents of Plainfield Tsunami Track Club, agree to stamp out bullying on our team. We believe that everyone should enjoy our team activities equally and feel safe, secure, and accepted regardless of color, race, gender, popularity, athletic ability, intelligence, religion, and nationality. Bullying can be pushing, shoving, hitting, and spitting, as well as name-calling, picking on, making fun of, laughing at, and excluding someone. Bullying causes pain and stress to victims and is never justified or excusable as "kids being kids," "just teasing," or any other rationalization. Furthermore, the victim is never responsible for being a target of bullying.
By signing this pledge, we, the ATHLETES, agree to:
1. Value our athletic differences and treat others with respect.
2. We will not become involved in bullying incidents or be a bully.
3. Be aware of the team's policies and support system concerning bullying.
4. Report honestly and immediately all incidents of bullying to a coach.
5. Be alert in areas with less adult supervision, such as bathrooms, corridors, stairwells, etc.
6. Support athletes who have been or are subjected to bullying.
7. Talk to coaches and parents about concerns and issues regarding bullying.
8. Work with other athletes and coaches to help the team effectively deal with bullying.
9. Encourage our coaches to discuss bullying issues with the team.
10. Provide a good role model for the younger athletes and support them if bullying occurs.
11. Participate fully, and contribute to team meetings dealing with bullying.
I acknowledge that whether I am being a bully or see someone being bullied if I don’t report or stop the bullying, I am just as guilty.
By signing this pledge, we, the PARENTS, agree to:
1. Keep ourselves and our child(ren) informed and aware of team bullying policies.
2. In partnership with the coaches, work to encourage positive behavior, valuing differences and promoting sensitivity to others.
3. Discuss their feelings about the team, friendships, and relationships regularly with our children.
4. Inform coaches of changes in our child(ren)'s behavior or circumstances at home that may change a child's behavior with the team.
5. Alert coaches if any bullying has occurred.