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Capital of Texas Heat Track Club |
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Post Office Box 15665 |
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Austin, Texas 78761-5665 |
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(512) 929 7273 |
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Emergency Medical Treatment Consent |
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Mission Statement: To offer lifelong progress of amateur athletics track and field competition for youth of all ages, races and creed, to enhance the physical, mental and moral development to promote good sportsmanship, good citizenship and safety, to utilize these skills to pursue secondary education and become resourceful citizens in their community. |
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Back to Registration Home Page |
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| In case of illness or accident, I, ____________________________________, give my permission for the emergency medical treatment of my child, ___________________________________, if I cannot first be contacted. My home telephone number is (_____) _____________________. |
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| I understand that I am responsible for all costs associated with the medical treatment of my child. |
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| _________________________________________ |
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| Signature of Parent/Guardian |
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| SUBSCRIBED AND SWORN TO before me, this ____________ day of |
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| ___________________, 20___________. |
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| _________________________________________ |
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| NOTARY PUBLIC in and for the State of Texas |
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| _________________________________________ |
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| Commission expiration date |
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