Oregon Street Vaults Entry Form

[rainbowgirl28]

Cool looks like they added another one on Aug 10th.

>Street Vaults
>Hosted by Vertical Vault Club Sanctioned by USA Track & Field
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>Name (Last) _______________________________ (First) _____________________________ Gender: M or F
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>Address: __________________________________________________ email: ____________________________
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>City: ________________________________ State: ______ Zip: ___________ Phone#: __________________
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>Birth Date: ____/____/____ Age Today: ______ Club: ____________________________________________
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>USATF Membership #: ___/___/___/___/___/___/___/___/___/___ Best Height: _____________
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>Pole Vault Awards: ____________________________________________________________________________
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>Other Sports Awards: __________________________________________________________________________
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>My Claim To Fame: ____________________________________________________________________________
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>In Case of Emergency:
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>Emergency Contact Person: _____________________________________ Phone #: ________________________
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>Health Insurance Co: ___________________________________________ Policy #: ________________________
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>Release of Liability
>By Signing, I understand the rules and procedures of pole vault, and I am aware of the risks involved in pole vaulting. I hereby state that I/my son/daughter have/has had and passed a physical examination in the past year and that I/he/she is in good health in which I/he/she is able to compete in the rigors of pole vaulting. I/he/she also understand(s) the necessity of using the proper technique while participating in this meet. I hereby assume all responsibilities for myself or my son/daughter and I hold the Vertical Vault Club, the cities of Portland, Salem and Corvallis, the State of Oregon, Beaumont Middle School, Foot Traffic, The Boys and Girls Clubs of Corvallis, Sovern & Company and the USA Track & Field Association and any one associated with these entities and/or any other sponsor(s) or supporters, harmless for any and all accident(s), injury, death, or damages occurring by participating in this event.
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>Signature of Parent: __________________________________________Date: _________________________________
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>Signature of Athlete: _________________________________________ Date: _________________________________
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>For more information regarding these meets, call Paul Wilson 503-393-2810
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>Mark Which One(s) You Will Attend & Email to gailkleinke@yahoo.com
>_____July 26 Downtown Salem _____August 2nd Downtown Portland _____August 10th Corvallis
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>Entry Fee: $15 for competition forms emailed or faxed (503-371-8668) by July 25th (Pay day of meet).
> $20 for Day of Meet Entry