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Standard (scholastic) Relays: $95 per relay
-- Youth (bantam, midget, youth): $30 per relay
NO DAY OF MEET ENTRY! *** USE BLACK INK *** NO
FAXED ENTRIES!
(*** ENTRY WILL BE REJECTED AND RETURNED IF RELAY NAMES ARE NOT
LISTED)
--- MAXIMUM 5 ATHLETES PER RELAY --- ENTER ONE RELAY PER RELAY ENTRY
FORM ---
--- RELAY MEMBERS MUST ATTEND THE SAME HIGH SCHOOL FOR NON-YOUTH
EVENTS. ---
School (or club, for Youth)_______________________________ City
____________________ State _____
Coach's Name __________________________ Phone (___
)____ - __________ email___________________
RELAY (circle one):
4x100 - 4x200 - 4x400 - 4x800 - 4xMile - 800m Med - 1600m Med -
DMR - Male Female (circle one)
YOUTH EVENTS (circle one):
bantam 4x100 - midget 4x100 - youth 4x100 - bantam 4x400
- midget 4x400 - youth 4x400 -- Male Female (circle one)
Qualifying Performance _________________ FAT /
HAND Meet _____________________ Date ___________
RELAY MEMBERS (Last Name, First Name) ***
NO HIGH SCHOOL ALL-STAR RELAYS PERMITTED ***
Name # 1 ____________________________ _________________________
____
Last First MI -- Phone (____ )____ - __________ e-mail___________________
Home Address__________________________________ City ___________________
State ____ Zip_______
USATF#_______________ Birthdate (mm/dd/yy)___________ Grad Year
__
____ Sex: M F (circle one)
Name # 2____________________________ _________________________
____
Last First MI -- Phone (____ )____ - __________ e-mail___________________
Home Address__________________________________ City ___________________
State ____ Zip_______
USATF#_______________ Birthdate (mm/dd/yy)___________ Grad Year
______ Sex: M F (circle one)
Name # 3____________________________ _________________________
____
Last First MI -- Phone (____ )____ - __________ e-mail___________________
Home Address__________________________________ City ___________________
State ____ Zip_______
USATF#_______________ Birthdate (mm/dd/yy)___________ Grad Year
______ Sex: M F (circle one)
Name # 4____________________________ _________________________
____
Last First MI -- Phone (____ )____ - __________ e-mail___________________
Home Address__________________________________ City ___________________
State ____ Zip_______
USATF#_______________ Birthdate (mm/dd/yy)___________ Grad Year
______ Sex: M F (circle one)
Name # 5____________________________ _________________________
____
Last First MI -- Phone (____ )____ - __________ e-mail___________________
Home Address__________________________________ City ___________________
State ____ Zip_______
USATF#_______________ Birthdate (mm/dd/yy)___________ Grad Year
______ Sex: M F (circle one)
WAIVER: In consideration of my the above athletes
entry in the adidas Outdoor Championships; I automatically waive
and release all claims for damages and injury I may have against
the competition and all its sponsors including, but not confined
to the National Scholastic Sports Foundation, Inc., North Carolina
State University, adidas USA, Inc., and any and all participating
sponsors and/or representatives. I verify they are physically fit
and have trained for this competition. I further grant full permission
to any and all of the foregoing and/or their representatives to
use any photographs, names and/or video for legitimate purposes.
Coach's Name ___________________________________
Signature ___________________________
adidas Outdoor Championship home page
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