SOUTHEASTERN CT REGIONAT TRACK MEET
May 15 - Ledyard High School
Registration - 5:00 - 5:45pm Meet Begins - 6:00pm
Towns of East Lyme, Groton, Ledyard, Montville, New London, Norwich, Stonington & Waterford
PARTICIPANT REGISTRATION FORM
child Name:
{Las0
cender:n Malen
Parent's cell Phone#:
Parenfs Home Phone #:
ofbinh:Month
Female
zip:
state:
City:
Date
(M.r.)
(Firs0
Day_Year_Age
as May 15,2015:
Additional Emergency Contact (if any):
Relahonghip:
Name:
Pafticipants can enter 3 EVENTS. Please circle the events you wish to padicipate in atthis meet. MAKE SURETO CIRCLE YOUR CHOICES
IN THE APPROPRIATEAGE GROI.'P.
Bovs&cirls8&under
Bovs&cirls9-10
Bovs&cirlsu-12
Bovs & Ghls 13
meier dash
2.400 meter dash
1. 100 meter dash
1. 100 meter dash
2.200 meter dash
3.400 meter dash
4- 800 meter dash
5- 1600 meter run
1. 100 meter dash
2. 200 meter dash
3.800 meter dash
6. StandingLonglump
7. SoftballThrow
6. SoftballThrow
1- s0
3. Standing LongJump
4. SoftballThrow
2. 200 meterdash
3.400 meter dash
4.800 meter dash
5. 1600 meter run
6.Standingtonglump
-
14
4. 1600 meter run
5. Standing Longlump
The above naned pant.ipant and the partjctpant's parent/guardian have requ€sted regisnation ofthe participant in theSoutheasteh CT ReAionalTrack Meet.ln
considerauon ofsuch re8Gtrarion, the ri8ht ofthe particlpantro compete in theSouiheastern cT RegionalTE.k Meetand the use bythe participait ofthe sponsoinS
ageicy,s fa.itiries and equipmen! both the participanr and the parenvgu:rdian each acknowledgethar the participant willbe competinc in th€ southeastern cT Regional
Track M€er, travetiiC, and ustngsponsoring ageicy'sfaciLities atthe participantt sole risk and lhe participant, on hk or herown beha fand on the behalfof his or
her h€irs, €xecutors, adoiiGtratoc and asiigns herebv releases, discharsdand agr€es to hold harmlesstheTowns of East Lym€,6roton, Ledyard, Montville, New london,
Notujch, stonington, and waierford, staff, and !o !ntee6. we a so agree to a low theTowns of Easi Lyme, Groton, Ledyard, Montville, New London, Norwich,
sionington, and walerford to us€ and rEproduc€ the panictpant's name andlor likenessand/or information concerningthe parucipant and to circulatethe same forany
andat purpos€sinanymanner.wecenifythatrh€intormationonthkparu.ipationformh.ori€ct.lund€rstandandagreethatthisreeasewil applytoanyandall
€ventsandaclivliiesmVchildmayparuclpateinasaparticipanllntheSoutheasternCTReEionalTrackMe€t
Signature of parcnt/guardian:
Date: