CUCO Track Club Registration

CuCo Track Club Team Registration

www.werunthebeach.com
Registration
Athletes Name*

First NameLast Name
As of December 31st 2023
Gender

MaleFemale
Birth Date:

DayMonthYear
Athletes School
Current and/or previous sports
Parents Information
Name

First NameLast Name
Phone Number:*
E-mail*
example@example.com
Address:

Street Address

Street Address Line 2

CityState

Postcode
Emergency Contact
Name

First NameLast Name
Phone Number

Photo/Media Release Form

Please Read & Sign
Photo/Video Release and Waiver

I The parent guardian of the above listed minor, hereby give my permission to Cuco Track Club, to use photographs, voice recordings, or video taken of the above listed minor during the games and events associated with Cuco Track Club in any manner to help promote the league activities as determined in the sole discretion of the Cuco Track Club. Such use could include publications, media releases, public announcements, electronic or otherwise, and on league websites or social media pages. I agree that neither I, nor the above listed minor, will receive any compensation if such image appears in any of the manners listed above or other manner that the league deems appropriate. I agree that such image is the property of Cuco Track Club
Signature

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Physical form upload

Upload athletes physical from doctor
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Upload a Picture Copy of Athletes Birth Certificate

Use Smartphone, Take a Picture & Upload
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Signature

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WAIVER/RELEASE FOR COMMUNICABLE DISEASES INCLUDING COVID-19

ASSUMPTION OF RISK / WAIVER OF LIABILITY / INDEMNIFICATION AGREEMENT

In consideration of being allowed to participate on behalf of Cuco Track Club athletic program and related events and activities, the undersigned acknowledges, appreciates, and agrees that:

1.    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,

2.    I KNOWINGLY AND FREELY 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 participation; and,

3.    I willingly agree to comply with the stated and customary terms and conditions for participation as regards protection against infectious diseases. If, however, I observe and any unusual or significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately; and,

4.    I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS (insert name of sports organization) their officers, officials, agents, 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.

FOR PARTICIPANTS OF MINORITY AGE (UNDER AGE 18 AT THE TIME OF REGISTRATION)

This is to certify that I, as parent/guardian, with legal responsibility for this participant, have read and explained the provisions in this waiver/release to my child/ward including the risks of presence and participation and his/her personal responsibilities for adhering to the rules and regulations for protection against communicable diseases. Furthermore, my child/ward understands and accepts these risks and responsibilities. I for myself, my spouse, and child/ward do consent and agree to his/her release provided above for all the Releasees and myself, my spouse, and child/ward do release and agree to indemnify and hold harmless the Releasees for any and all liabilities incident to my minor child’s/ward’s presence or participation in these activities as provided above, EVEN IF ARISING FROM THEIR NEGLIGENCE, to the fullest extent provided by law.
Parents Signature

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Cuco Athletics Club’s mission is to surround students with a community of support, empowering them to stay in school and achieve in sports and life. We are committed to helping students achieve success in school by providing various support services and enrichment experiences to meet academic and non-academic. As a result, our youth will be better equipped to find meaningful employment, lead productive, gratifying lives, and become contributing members of our society.

Dear Parent/Guardian:

My name is Omar Green I will be your point of contact for any questions you may have about any Cuco Athletics Club-related services. Your consent is required for your child's general participation in Cuco Athletics Club Mentoring programs and service referrals.
Please complete the following:
I give permission for my son/daughter,
your name to participate in Cuco Athletics Club programs while he/she in enrolled at students school or until I notify CUCO, in writing, of my desire to withdraw my student from cuco services.
Name

First NameLast Name
DCPS Student Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth

MonthDayYear
Date
Gender
Grade
Race
Cell Phone Number

By signing this Parent Consent/Release of Information, I authorize the following:
I permit my child to participate in the program. The services may include but are not limited to supportive guidance/counseling, educational support, tutoring, mentoring, enrichment activities, testing, and referrals to other agencies as needed.
I permit my child to participate in field trips and other activities sponsored by CUCO. I approve of private transportation (charter bus, city bus, uber or taxi) provided in these and other activities.
I permit routine or emergency medical or dental treatment by any licensed medical practitioner to be provided in the event of illness or accident if I am unable to be reached. I further state that I will not hold CUCO ATHLETICS CLUB , Duval County, or any other authorized worksite, organization, or agency liable for medical treatment in case of illness, accident, or any other emergency.
I acknowledge that this consent is voluntary and may be revoked at any time by informing CUCO staff, in writing, except that prior consent will still apply to the extent that agencies have already acted in reliance on it.
I acknowledge that the release of records under this consent is subject to any limitations placed by federal and state law.
I understand that the data and information collected on my child are maintained in a secure computer database and a case file. CUCO uses this information to document services provided to students and families for tracking and reporting purposes. I also understand that CUCO may use the information to update service information, provide closure and follow-up information, and evaluate and determine the program's effectiveness. I authorize CUCO to maintain the information provided for the purposes noted above in the CUCO computer database and case file.
This data collection may include, but is not restricted to, the following:
Enrollment status
Attendance
Behavior records
Demographic information (race/ethnicity, gender, etc.)
Grade reports, test scores, and transcripts
Surveys and interviews about his/her/their knowledge, attitudes, or skills.
I understand that this information will remain confidential and that only approved staff, volunteers, or CUCO agents will be to access and look at my child's data.
I also understand that my child's responses are automatically grouped with other students' responses for any public presentations of findings, and my child will not be individually linked to his/her answers.
I acknowledge that I have the right to inspect and obtain a copy of any record released by this consent upon request in writing to the releasing agency, subject to any applicable copying costs and legal limitations.
I give my permission to CUCO to photograph, film, video, and make sound recordings of my child, to quote or publish statements of my child, and to use such photographs, movies, video, audio recordings, and other comments for educational and promotional/advertising materials.
To further my child's academic, personal, and vocational development, I will participate in at least two parent-team conferences per year to discuss my child's progress (through either a home visit or a school visit).
Name of Parent Gaurdian

First NameLast Name
Signature

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Parent or Gaurdian Email
example@example.com
Emergency Contact Name

First NameLast Name
Emergency Contact Phone Number
Should be Empty:

CuCo Track Club Team Registration

Photo/Media Release Form