3rd Annual Hot Springs Street Vault

Registration

Name:_______________________Age:________Gender:  M / F

Address:______________________Phone:_____________

  ______________________

Email:__________________________________USATF #____________

Division:  (circle)PR:______

Youth          Open

IntermediateSr.

Young    Pro

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,  and it's 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 $30.00 fee and USATF membership# to:

Arkansas Vault Club

149 River Road

Norman, AR  71960