1. 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,
Vaulting information, jump times & additional instructions will be ed 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: ________________
__________________________________________________________
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)