Gender_______ Grade ____
Entry Limits: 3 events plus a relay
or 2 events plus 2 relays ____50m | ____400m Run | ____Sprint
Hurdles | ____Long Jump |
| ____100m Dash | ____800m Run | ____4
x 100m Relay | ____High Jump |
| ____200m Dash | ____1500m Run | ____4 x 400m Relay | ____Shot Put |
If you are running
in a relay fill out the info below:
4 x 100 – 1)
2)
3)
(List three relay team members that are running with you)
4 x 400 - 1)
2)
3)
(List three relay team members that are running with you)
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Athlete’s Name: _______________________________________________________________________
Address: _____________________________________________________________________________
City: _________________________ State: ____________
Zip Code: ___________________
Phone Number :(______)
Emergency Information: _____________________________________________________________________________
Parent(s)/Guardian(s) Name(s) for minors Emergency number other than that listed: ____________________________________________________ The above named participant (and the
participant’s parent/guardian if participant is a minor) has (have) requested registration of the participant in the
Northstar United All-Comers Track and Field Meet. In consideration of such registration, the right of the
participant to compete in the Northstar United All-Comers Track and Field Meet and the use by the participant of the sponsoring
agency’s facilities and equipment, the participant (and the parent/guardian) each acknowledge that the participant will
be competing in the Northstar United All-Comers Track and Field Meet and the sponsoring agency’s facilities at the participant’s
sole risk and the participant, on his or her own behalf and the on the behalf of his or her heir, executors, administrators
and assigns hereby release, discharge and agree to hold harmless Northstar Youth Club and its officers, Independent School
District 196 and Eagan High School, the and Northstar United Track Team, USATF MN, and the volunteer or paid meet officials.
I/we certify that the information on this participation form is correct.
(Signature of
Athlete)
(Date)
(Signature of Parent/Guardian for Minors participating)
(Date)
Or Mail to:
Northstar
Youth Club
Attn: Jeff Freeman
13220 Grand Oak Ct.
Apple Valley, MN 55124
