Name_____________________Birthdate____________Female____Male____

Street_____________________City________________State  _ __Zip_______

USATF CLUB:____________________________________________________

USATF #_________________________________________________________

                                                DIVISION:   
 Please Check One

Division    Age Group 2007 2008 2009
Sub Bantam   6-8 1999+ 2000+ 2001+
Bantam   9-10 1997-98 1998-99 1999-2000
Midget   11-12 1995-96 1996-97 1997-98
Youth   13-14 1993-94 1994-95 1995-96
Intermediate   15-16 1991-92 1992-93 1993-94
Young Men/Young Women   17-18      1989-90 1990-91 1991-92

 

EVENTS ENTERED:
SubBantan, Bantam and Midget Divisions may enter only three (3) events. Relay participation
 counts as an event.

1: ___________________________  2:_____________________________

3: ___________________________  4:_____________________________

                                      

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Release of Liability Statement

Must be signed by both parent/guardian and athlete.

In consideration of acceptance of this entry, I/we shall hold harmless all individuals and parties 
associated with the operation of this Junior Olympics Meet from any claim for injury and/or loss 
which might occur as a result of participation in or during theprocess of travel to or from the event.

Athlete's Signature:_____________________________Date:_____________

Parent/Guardian Signature:______________________ Date:_____________

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Proof of Age: The form of proof shall be a readable copy of a birth certificate, passport, certified 
baptismal record, driver's license or U.S. Government ID. Letters from school, track club officials or 
recreation offices will not be accepted as proof of age.