Needham Track Club

c/o John Hrones

53 Coulton Park

Needham, MA   02492

Email 

to needhamtrackclub@aol.com

$11  Advance Registration   Includes:   3 individual events- no more 

                                                            than 2 running + relay

$5  Extra for additional event, maximum of 5 events    

$10 per relay team

$3  Spectator Admission (age 12+)

Make checks payable to  Needham Track Club

      Info at Needham Track Club: 

                               (781) - 559-8388

       and             www.needhamtrack.org

Child's Name ______________________________________  Sex _____   Age (2/11/07) _____  

Date of  Birth ________________     

Child's Name ______________________________________  Sex _____   Age (2/11/07) _____ 

Date of  Birth ________________    

Team Name ( team affiliation is not required) ________________________________________

Street _____________________________________________________________________

Town _____________________________________  State _________   Zip ______________

In consideration of the entry being accepted, I hereby for myself, my heirs, executors, and administrators, waive and release any and all rights and claims for damages I may have against the Needham Track Club and Massachusetts Institute of Technology, its agents, representatives, successors, assigns, and any individuals associated with this event for any and all injuries suffered by my children at this event.   I assume all risks associated with participating in this event including, but not limited to: falls, contact with other participants, officials, or spectators, all such risks being known and appreciated by me.  I attest that my children are physically fit and trained to compete in this meet.

Signature   ___________________________________________    Date ________  

                               (parent or guardian)

Phone ________________________  Email (Please Include)  ___________________________________