Pottsville Recreation Commission 2014 Local Meet Entry Form

(Please Print)

Name BOY GIRL

(Last) (First) (MI) (Circle one)

Address

City State Zip

School

Phone Date of Birth Age as of Dec 31, 2014

  • Eligibility: boys & girls ages 5-14 as of December 31, 2014
  • All participants must compete in their age group and sex division.
  • Pottsville, Minersville, Schuylkill Haven or St.Clair School District students only.

Any participant not registered at one of these local school districts will be disqualified.

  • Events for age groups 5-6 & 7-8 are fun runs; they do not advance to the Hershey’s District Meet.
  • First place finishers in age groups 9-10, 11-12 & 13-14 qualify for the Hershey’s District Meet, TBA
  • A participant may enter only one local meet
  • Participants can enter three events; two track and one field event or two field and one track event

(9-10 & 11-12 can enter the 4 X 100 relay as a 4th event but will not advance to State Meet in this event)

CHOOSE UP TO THREE EVENTS FROM THE LIST BELOW AND ENTER THE INFORMATION ON THE EVENT SIGN-IN SHEET

AGE 5-6 BORN 08-09 AGE 7-8 BORN 06-07

1) 50 M DASH 54 YDS/24.5” 1) 50M DASH 54 YDS/24.5”

2) 100M DASH 109 YDS/13.0” 2) 100M DASH 109 YDS/13.0”

3) STANDING LONG JUMP 3) 200M DASH 218 YDS/16.0”

4) SOFTBALL THROW 4) STANDING LONG JUMP

5) SOFTBALL THROW

AGE 9-10 BORN 04-05 AGE 11-12 BORN 02-03 AGE 13-14 BORN 00-01

1) 50M DASH 54 YDS/24.5” 1) 100M DASH 109 YDS/13.0” 1) 100M DASH 109 YDS/13.0”

2) 100M DASH 109 YDS/13.0” 2) 200M DASH 218 YDS/16.0” 2) 200M DASH 218 YDS/16.0”

3) 200M DASH 218 YDS/16.0” 3) 400M DASH 436 YDS/32.0” 3) 800M RUN

4) 400M DASH 436 YDS/32.0” 4) 800M RUN 4) 1600M RUN

5) 4 x 100M RELAY 5) 4 X 100M RELAY 5) 4 X 100M RELAY

6) STANDING LONG JUMP 6) STANDING LONG JUMP 6) STANDING LONG JUMP

7) SOFTBALL THROW 7) SOFTBALL THROW 7) SOFTBALL THROW

Emergency Information:

Mother, Father or Guardian’s name and phone #

The above named participant’s parents or guardian have requested registration of the participant in the Pottsville Recreation Commission local event of Hershey’s Track & Field Games. In consideration of such registration, the right of the participant to compete in the Hershey’s Track & Field Games and the use by the participant of the sponsoring agency’s facilities and equipment, both the participants and the parents/guardian each acknowledge that the participant will be competing in the Hershey’s Track & Field Games local events and sponsoring agency’s facilities at the participant’s sole risk and the participant on his or her own behalf of his or her heir, executors, administrators and assigns hereby release, discharge and agree to hold harmless the City of Pottsville and the Pottsville Recreation commission, Hershey Company and its franchises and the National Recreation and Park Association, USA Track & Field and Athletics Canada. We also agree to allow Hershey’s Track & Field Games to use and reproduce the participant’s name and/or likeness and/or information concerning the participant and to circulate the same for any and all purpose in any manner. We certify that the information on this participation form is correct.

(signature of parent/guardian)(date)