Entry Form

Name_____________________Birthdate____________Female____Male____

Street_____________________City________________State _ __Zip_______

USATF CLUB:____________________________________________________

USATF #_________________________________________________________

DIVISION:
Please Check One

Current Year

Division	Age Group	2009	2010	2011	2012	2013
Sub Bantam	6-8	2001+	2002+	2003+	2004+	2005+
Bantam	9-10	1999-2000	2000-01	2001-02	2002-03	2003-04
Midget	11-12	1997-98	1998-99	1999-2000	2000-01	2001-02
Youth	13-14	1995-96	1996-97	1997-98	1998-99	1999-2000
Intermediate	15-16	1993-94	1994-95	1995-96	1996-97	1997-98
YM/YW	17-18	1991-92	1992-93	1993-94	1994-95	1995-96

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.