Capital City Strider's
On-Line Registration
Athletes Name:
January
February
March
April
May
June
July
August
September
October
November
December
Male
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Female
Athletes Date of Birth
Age
Turning this Year
Parent/Guardian Information:
Parent/Guardian Name:
Address:
State:
City:
Zip:
Primary Phone:
Cell Phone:
Alternate Phone:
E-Mail Address:
Emergency Information:
Emergency Contact Name:
Emergency Contact Phone:
Emergency Contact Name:
Emergency Contact Phone:
Health Information:
List any Health Information: