Rider NameLandon Jacobs
Current Age of Rider14
Age of Rider as of December 31, 202415
Cycling Discipline (check one or more)
  • Road
  • Mountain
TeamsHighlanders Only ($320.00)
Team LevelWhite Team - Goals / Commitments
Which high school will you attend in Fall 2024?Liberty High School
USAC Cycling License #661613
Medical Insurance CarrierUnited Healthcare
Parent Name (Primary Contact)Lindsey Jacobs
Parent Cell Phone #(314) 814-0259
Parent Email AddressEmail hidden; Javascript is required.
2nd Parent NameJoe Jacobs
2nd Parent Cell Phone #(314) 607-4388
Emergency Contact Info
Emergency Contact NameNan Hargett
Emergency Contact Phone #(479) 650-5381
1. Has a doctor ever limited your physical activity due to a heart, lung or other condition?No
2. Do you have pains in your chest while performing physical activity? or at other times?No
3. Do you ever feel faint or have spells of severe dizziness or unconsciousness?No
4. Has a doctor ever said your blood pressure was too high?No
5. Has your doctor ever told you that you have a bone or joint problem(s), such as arthritis that is aggravated by exercise, or might be made worse with exercise?No
6. Are you NOT accustomed to vigorous exercise?No
7. Do you suffer from any problems of the lower back, i.e., chronic pain, or numbness?No
8. Do you have a disability or other physical limitation that would inhibit participation in a vigorous exercise or certain physical activities?No
9. Are you currently taking any medications (prescription or other)? If YES, please specify.No
10. Do you currently have a chronic illness or a communicable disease?No
11. Do you have any allergies (medicine, bees or other stinging insects)?No
12. Do you, or have you had seizures?No
13. Have you ever had a head injury? Been knocked out? Or knocked unconscious?Yes
14. Are you missing or overdue on any standard shots (like tetanus, immunizations, etc.)?No
15. Is there any other reason, condition, or other health information the coaching staff should be aware of, or that would limit your participation in a vigorous exercise program?No