Jack Frost Vault Meet
December 17, 2011
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:__________Beginner: Boys GirlsNovice: Boys GirlsIntermediate: Boys GirlsYoung: Men Women Open: Men WomenRELEASE 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 $25.00 fee and USATF membership# to:
Arkansas Vault Club
149 River Road
Norman, AR 71960
