Vertical Adventures
Entry Form: Vertical Club Winter 2002


Name_______________________________ Dec 11
Address_____________________________ Dec 18
City________________________________ Jan 2
State_______________________________ Jan 8
Zip Code____________________________ Jan 15
Events______________________________ Jan 22
Age___________     Sex:   Male     Female Jan 29
Email_______________________________ Feb 5
Telephone___________________________ Feb 12
Grade Fall '2001______________________ Feb 19
School_______________________________ Feb 26
Payment Enclosed $ ____________________

Fee Per Meet/Clinic:

  $15   Youth Athletes (Minimum of 7 "Pre-entries" per date needed to guarantee clinics!)
$10 High School & Up Athletes (Register Early, Space is Limited!)
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 "Vertical Club" Winter Pole Vault & High Jump Clinic & Competition 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, National Guard Armory, Robert Amos, 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 _____________


 
© Copyright 2001 Vertical Adventures. All rights reserved.