Rider Name | Miloh Plath |
---|---|
Current Age of Rider | 13 |
Age of Rider as of December 31, 2024 | 13 |
Cycling Discipline (check one or more) |
|
Teams | Front Rangers Only ($220.00) |
Medical Insurance Carrier | Cigna |
Parent Name (Primary Contact) | Ashley Plath |
Parent Cell Phone # | (719) 203-0528 |
Parent Work Phone # | (719) 328-7200 |
Parent Email Address | Email hidden; Javascript is required. |
2nd Parent Name | Caleb Plath |
2nd Parent Cell Phone # | (719) 313-2606 |
Emergency Contact Info | |
Emergency Contact Name | Kim Plath |
Emergency Contact Phone # | (719) 659-3847 |
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? | No |
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 |