Jack Frost Vault Meet
December 27, 2009
Registration
Name:_______________________
Age:________Gender: M / F
Age:________Gender: M / FAddress:______________________Phone:_____________
Phone:_____________ ______________________Email:__________________________________USATF #____________
USATF #____________Division: (circle)PR:______ T Shirt Size:__________
PR:______ T Shirt Size:__________BeginnerJr. High: Girls BoysHigh School: Girls BoysOpen: Women Men RELEASE OF CLAIMS
It is my understanding that there are certain risks involved with participating in the pole vault.
In recognition of the possible dangers connected with pole vaulting and any physical activity, I hereby knowingly and voluntarily waive and right of cause of action of any kind whatsoever arising as a result of such activity, from which any liability may or could accrue to Morry Sanders, Steve Irwin, Arkansas Vault Club, USATF and their officers, agents, employees, or instructors.
If under eighteen (18) years of age, parent or legal guardian must sign.
____________________________________
Signature Date
____________________________________
Parent/Guardian Date
Mail entry form with $20.00 fee and USATF membership# to:
Arkansas Vault Club
149 River Road
Norman, AR 71960
