Shoe ID Submission Form

Fleet Feet Sports Winston-Salem asks that all training participants assist in promoting safety by wearing a Shoe ID.

Please complete the form to order your Training Shoe ID.

Shoe ID

Password

Please enter the password you received upon purchase

First and Last Name (i.e. Jane Smith)*

Insert Complete First and Last Name

Phone (i.e. XXX-XXX-XXXX)*

Insert Your Phone Number Including Area Code

Check All Conditions That Apply

Contacts (Check all conditions that apply)

Check All Conditions That Apply

Asthma (Check all conditions that apply)

Check All Conditions That Apply

Diabetes (Check all conditions that apply)

Check All Conditions That Apply

High Blood Pressure (Check all conditions that apply)

Blood Type

Insert Blood Type

Other (Insert any medical conditions or concerns that may apply)

Insert any medical conditions or concerns that may apply.

Emergency Contact First and Last Name (i.e. Joe Smith)*

Insert First and Last Name of Emergency Contact

Emergency Contact Phone (i.e. XXX-XXX-XXXX)*

Insert Emergency Contact's Phone Number

Medications (List important medications currently taking regularly)

List Important Medications Currently Taking Regularly

Allergies (List any allergies including medications)

List Allergies Including Allergies to Medication