Training Young Champions
704.840.8936
Lisa@Fit180Athletics.com
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Register for Cross Country
Registration: Cross-Country
Please fill out all of the required fields below to register your athlete for a Fit180 Athletics Program.
Step
1
of
5
- Athlete Information
0%
Select Your Option
*
Cross-Country $219
Add Pre-Conditioning?
*
Pre-Conditioning + $80
No Pre-Conditioning
Choose Location
*
Ballantyne District Park
William Davie Park (S.Charlotte)
Marvin Efird Park
Athlete's Information
Please fill out all of the required fields in this section.
Athlete's Name
*
First
Last
Gender
*
Male
Female
Hidden
Qualification
*
My School does not have a cross-country program
I am a homeschool athlete
Fit180 XC is open to homeschoolers and athletes attending schools that have no cross country program. Athletes must qualify under one of the above choices.
School
*
Grade
*
Select Grade Level
5th
6th
7th
8th
9th
Date of Birth
*
Birthday of Athlete
MM slash DD slash YYYY
First Time Registration?
*
If you have already completed a registration for this athlete for a former program, you can choose to SKIP or UPDATE your Contact and Medical Information.
This is the FIRST TIME my athlete has participated in any Fit180 Program
Athlete HAS PARTICIPATED in a former Fit180 program.
Has Your Medical and Insurance Information Changed?
*
This includes relevant conditions, critical allergies, over-the-counter medication, insurance and Doctor information. If nothing has changed since your last registration, please select No.
NO. My Medical Information has not Changed. Skip this section.
Yes. I need to UPDATE or PROVIDE medical information
Contact Information
Contact information is for advising and coordination of program information. This information is kept private and is not sold or offered to any 3rd party.
Primary Email : Parent/Guardian
*
Enter Email
Confirm Email
Additional Email (Optional)
Enter Email
Confirm Email
Parent Information
Mother's Name
First
Last
Mother's Cell
Father's Name
First
Last
Father's Cell Phone
Athlete's Home Address
*
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Other Authorized Guardian
*
All authorized guardians are listed above
I wish to authorize another authorized guardian for pickup/drop-off
Guardian's Name
First
Last
Cell (Additional Guardian)
Medical & Insurance Info
Medical Information
Please fill out all fields in this section
Medical or Allergy Conditions
*
By signing this form, you are affirming that our child is medically and physically fit to take part in strenuous exercise. However, if there is anything we should know regarding allergies, medicine, or medical conditions, please select the second option and let us know.
My child has NO medical or allergic conditions that you need to be aware of.
My child has a medical or allergic condition you need to be aware of.
Please list anything your child is allergic to (drugs, pollen, nuts, etc):
*
Does your child have any of the following?
Asthma (incl. exercise-induced asthma)
Diabetes
Epilepsy
Is your child currently taking any medications that we should be aware of?
*
Yes
No
Please list those medications:
*
Is there additional information we should know about your child's health or physical condition?
*
Yes
No
Also use this to explain any conditions listed above.
Please explain:
*
Insurance Information
Please fill out all fields in this section.
Name of Insurance Company
*
Policy Name and Number
*
Physician's Name
*
Dr's Phone
*
Informed Consent and Terms & Conditions
Authorization for participation and emergency treatment.
*
I hereby give permission for my athlete (Named Above), to participate in Fit180 Athletics programs. Further, I authorize the club to provide emergency treatment of any injury or illness my child may experience if qualified medical personnel consider treatment necessary and perform the treatment. This authorization is granted only if I cannot be reached and reasonable effort has been made to do so. My child and I are aware that participating in conditioning, track and field and cross country is a potentially hazardous activity. We assume all risks associated with participation in this sport, including, but not limited to falls, contact with other participants and other reasonable-risk conditions associated with the sport. All such risks to my child are known and understood by my child and me. We understand this informed consent form and agree to its conditions.
COVID-19 Risk Acknowledgement and Release.
*
In consideration of my minor athlete (ATHLETE) being allowed to participate in any Fit180 Athletics program(s) and related events and activities, the undersigned acknowledges, understands, and agrees that: Participation includes possible exposure to and illness from infectious diseases including but not limited to MRSA, influenza, and COVID-19. While particular rules and personal discipline may reduce this risk, the risk of serious illness and death does exist; and, I KNOWINGLY AND VOLUNTARILY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my ATHLETE’S participation; and, I willingly agree to comply with the stated and customary terms and conditions for participation as regards to protection against infectious diseases. If, however, I observe any unusual or significant hazard during my ATHLETE’s presence or participation, I will remove my ATHLETE from participation and bring such to the attention of a Fit180 Athletics staff person immediately; and, I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS Fit180 Athletics, their officers, officials, agents, coaches and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event (“RELEASEES”), WITH RESPECT TO ANY AND ALL ILLNESS, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF RELEASEES OR OTHERWISE, to the fullest extent permitted by law. I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IF FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
Image Release
*
In consideration of my minor child/ward being allowed to participate in any way in the Fit180 Athletics Club program, related events and activities, the undersigned agrees that such participants’ likeness may be photographed or videotaped and that such image may be published in our outlet used to promote or publicize the sports program.
Terms and Conditions
CODE OF CONDUCT Parents • Be a positive role model. • Encourage good sportsmanship among all athletes. • Be supportive of coaches and meet officials. • Respect the coach’s ability to teach and coach your child. Parents may discuss the training program with coaches following practice, if time permits. It is recommended that parents schedule time separate from practice to meet with the coach to discuss concerns. • Arrive to meets at the time given to you by the coach and check in at the designated team area. • Place the physical and emotional well-being of your child above any personal desire that they have to win. • Remember, children are involved in organized sports for their enjoyment, not ours. Be supportive and encourage them to enjoy themselves and to do their best. Athletes • Arrive at practice ready to listen, work hard, learn and give my best effort. • Do your best to be at every scheduled practice. Be on time and prepared. Late athletes will not be allowed to participate in training activities without completing a warm-up. Practices will not be delayed or extended to accommodate late arrivals. • Learn the rules and always compete by them. • Be respectful of coaches, officials, parents, teammates and competitors on other teams. Treat others as you wish to be treated. • Inappropriate behavior and/or language will not be tolerated. Conduct which is not in compliance with the Code of Conduct and/or which is detrimental to the club may result in an athlete's dismissal from the club. FEES WILL NOT BE REFUNDED IN THE EVENT OF DISMISSAL CANCELLATION POLICY for all Fit180 Programs. Cancellation Fee: There will be a $20 Cancellation Fee for any refund of funds at any time after payment has been received. Maximum Refund will be: (a) If more than 48 hours prior to the start of the program, you will receive a full refund, minus cancellation fee (above), and any other expenses that have been applied, such as uniforms, race fees, etc.., or (b) if after 48 hours prior to start of the program, Maximum refund will be 50% of total program fees. Fit180 Athletics holds the right to further prorate the refund based on the actual participation of the athlete, and expenses incurred. At no time will the refund be greater than 50% of total program fees.
Signature of parent or guardian
*
Type in your full name for an electronic signature. By signing above, you agree to the Terms and Conditions, Image Release, and Authorization for Participation as detailed above.
Options and Payment
Please select from the options below for Uniforms, Spirit Wear, and Payment Method.
FREE T-Shirt
This program includes a FREE T-Shirt for your athlete. Brand, Color, and Style may vary from year to year.
T-Shirt
*
T-Shirt - FREE
No Thanks
T-Shirt Size
*
Select T Size
YM
YL
AS
AM
AL
Uniform
UNIFORM
*
This program requires that each athlete wear a Fit180 Team Uniform (Jersey & Shorts) on day of race.
I need to buy a Uniform
Already have a Fit180 Uniform
Jersey
*
Black & White Fit180 Jersey
Jersey - $30
Already Have a Jersey
Jersey Size
*
Select Size
YM
YL
AS
AM
AL
Black Shorts
*
Black & White Fit180 Shorts. (Athletes may use their own all-black running shorts. No other color please!)
Shorts - $20
Already Have All Black Shorts
Shorts Size
*
Select Size
YM
YL
AS
AM
AL
Spirit Wear (Optional)
The following items are optional spirit wear items that are commonly purchased by our athletes. If you would like additional items (for parents or siblings), please contact Lisa directly at Lisa@fit180Athletics.com.
Personalized Hoodie
Great for staying warm while hanging out at the tent.
Order Hoodie
*
Hoodie - $38
No Thanks
Hoodie Size
*
Select Size
YS
YM
YL
AS
AM
AL
AXL
Personalization
*
What name do you want printed on the back? Default is your LAST NAME
Payment Method
Payment Method
*
You can pay by Check or Paypal. Please note that there is a $4.00 convenience fee associated with Paypal processing.
Select Payment Method
Pay by Check
PayPal*
Pay by Venmo
Total
$0.00
* There is a $4.00 charge for PayPal to help Service Fees
Please make checks payable to Fit180 Athletics.
Mailing Address:
Fit180 Athletics
Attn: Lisa Sluiter
2436 Logan Field Dr.
Waxhaw, NC 28173
USE YOUR PHONE and the VENMO App to remit payment to: @Fit180Athletics Or (Using the VENMO App) Scan the QR Code below.
Name
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Training Young Champions
Training Young Champions
