Vertical Adventures

Entry Form: Vertical Club Spring Clinic Series 2002
Medford, New Jersey
High Jump

Name_______________________________ May 2
Address_____________________________ May 9
City________________________________ May 16
State_______________________________ May 23
Zip Code____________________________ May 30
Events______________________________ June 6
Age___________     Sex:   Male     Female June 13
Email_______________________________    
Telephone___________________________    
Grade Fall '2002______________________  
School_______________________________    
Payment Enclosed $ ____________________
  Club Fee Per Clinic:
  $10   Pre-Entry Only
 
  Mail Checks Payable to:
Mike Pascuzzo/Vertical Adventures
1 Sheffield Lane
Mt. Laurel, NJ 08054

I hereby grant permission for my child to attend the Vertical Adventures Spring 2002 Vertical Club linic Series. I verify that my child has had a physical exam in the past year and is able to participate in the activities related to the meet series. I agree to indemnify, hold harmless and defend Vertical Adventures, Michael Pascuzzo, Robert Amos, Lenape High School and /or their agents or employees from any and all liability for injury, to my child, as well as any injury or damage caused by my child.

Parent or Gurardian Signature_______________________________  Date _____________

© 1992-2002 Vertical Adventures. All rights reserved.