Max Richey Street Pole Vault SATURDAY, July 1st

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Presentation transcript:

Max Richey Street Pole Vault SATURDAY, July 1st WHEN: Haynes-Apperson Sports Festival, Saturday, July 1st – group start times to be announced later beginning in the afternoon WHERE: Superior Street – across from Foster Park in Kokomo, Indiana GROUPS: grade school, high school, elite & masters (gals & guys) ENTRY FEE: $25.00 Make checks payable to: Randy Everetts - HA Street Vault Send check and entry to Randy Everetts, 3115 Timber Valley Dr., Kokomo, IN 46902 DEADLINE TO ENTER: Friday, June 16th to secure vault spot and t-shirt. For more information, please contact Randy Everetts, 765-450-4601 Vaulting information, jump times & additional instructions will be emailed by Wednesday, June 28th. Please register early! Also see Haynes-Apperson Street Vault Facebook site for past & present info NAME:____________________________________ AGE:_____ M or F:_____ ADDRESS: _______________________________________________________ PHONE: _____________________ EMERGENCY PHONE: ________________ EMAIL:__________________________________________________________ T-SHIRT SIZE: Adult: SM_____ MED_____ L_____ XL_____ 2XL_____ BEST VAULT: ________ POLE VAULT ACCOMPLISHMENTS: ______________ ________________________________________________ ________________________________________________________________ RELEASE For, and in consideration of my participation in any HAYNES-APPERSON DAY SPORTS FESTIVAL events and the prizes offered in connection therewith, I/WE may now have or have in the future against the HAYNES-APPERSON SPORTS FESTIVAL events, their agents, servants, employees, successors, and assigns, arising from any damages or losses which I/WE may suffer or incur while taking park in any HAYNES-APPERSON SPORTS FESTIVAL event. This waiver and release shall be binding upon my/our heirs, executors, administrators, and assigns. SIGNATURE_________________________________ DATE:_______________ (PARENT OR GUARDIAN, IF PARTICIPANT IS UNDER 18 YEARS OF AGE)