AGE DIVISION:________________ PRINT-PRINT-PRINT
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LAST
NAME, FIRST NAME) |
BIRTHDATE |
HOMETOWN |
EVENT
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EVENT
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EVENT
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EVENT
4 |
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Time/Dist/Ht. |
Time/Dist/Ht. |
Time/Dist/Ht. |
Time/Dist/Ht. |
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Doe,
Jane |
12/12/90 |
Miami, FL |
100
M |
Long
Jump |
High
Jump |
4x100 |
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(Example) |
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14.5 |
11'1" |
3'3" |
61.0 |
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I, the undersigned hereby certify that the athlete(s) identified about is/are, (1) entered in the proper division, based on year of birth; (2) physically sound and fit to compete in this meet; (3) Cognizant of (and will abide by) the eligibility requirements and the terms of the "HOLD HARMLESS STATEMENT". In consideration for my entry being accepted, I intend (Coach/Athlete(s)/Parents) to be legally bound, due to myself and/or team, my heirs, executors and administrators, THE MIAMI NORTHWEST EXPRESS TRACK CLUB, USATF-FLORIDA ASSOCIATION, and any agents, organization and/or co-sponsors.
Athlete/Team Official/Coach ________________________________ Date_____________________________
Parent/Guardian Signature __________________________________Date_____________________________