| Athlete's Name | Elijah Harder |
|---|---|
| Athlete's Birth Date | 01/23/2010 |
| Entry Date | 10/12/2025 |
| Insurance Provider | BCBSMT |
| Insurance Policy Number | 12345 |
| Primary Contact Name | Jeremy Harder |
| Primary Contact Email | Email hidden; Javascript is required. |
| Primary Contact Phone | (406) 581-3307 |
| Alt Contact Name | Kristin Gardner |
| Alt Contact Email | Email hidden; Javascript is required. |
| Alt Contact Phone | (406) 539-2350 |
| Optional Comments | Elijah is in DC for a school trip, but will be able to attend the last 4 days. Jeremy said this was ok to do. |