Bermuda Pacers Track Club

Please complete the below form only if instructed.

Intending to be legally binding and in consideration of your acceptance of this registration, I hereby release the Bermuda Pacers Track Club (BPTC), its Officers and Race Officials and all Race Sponsors from any claims from injury or damages regardless of how sustained during events organized by BPTC

* indicates required

Email Address (to be used for all communication) *

Additional Email (if applicable)

Mother/Guardian's Name *

Mother/Guardian's Phone Number *

Father/Guardian's Name

Father/Guardian's Phone Number

Athlete No. 1 - First Name *

Athlete No. 1 - Last Name *

Athlete No. 1 - Date of Birth (MM/DD/YYYY) *

MM/DD/YYYY

Athlete No. 1 - Gender *

Male
Female

Is the above athlete a NEW or RETURNING athlete? *

New Athlete
Returning Athlete

Please list your athlete's preferred events

Athlete No. 1 - School *

Athlete's Address *

Street Address Address Line 2 City State/Prov/Region Postal/Zip Country

Athlete No. 2 - First Name

Athlete No. 2 - Last Name

Athlete No. 2 - Date of Birth (MM/DD/YYYY)

MM/DD/YYYY

Athlete No. 2 - Gender

Male
Female

Please list your athlete's preferred events

Athlete No. 2 - School

Is the above athlete a NEW or RETURNING athlete?

New Athlete
Returning Athlete