_______________________________________

Child #1   First Name 

_______________

Age (7/27/2007)

_________________

Birth  Date

_________

Sex

_______________________________________

Last Name

Circle Options:

3rd  Individual

Running Event on

SAT  ($6 extra) 

Relay Team

(Extra $10)

_______________________________________

Child #2   First Name 

_______________

Age (7/27/2007)

_________________

Birth  Date

_________

Sex

_______________________________________

Last Name

Circle Options:

3rd  Individual

Running Event on

SAT    ($6 extra)

Relay Team

(Extra $10)

__________________________________________________________________________________

Address        Street                                                          Town                        State             Zip

In consideration of this entry being accepted,  I hereby for myself, my heirs, executor, and administrators, waive and release any and all rights and claims for damages I may have against the Needham Track Club, 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 attest that my children are physically fit and trained to compete in this meet.

__________________________________________

Signature (parent / guardian)

___________    ( ______ ) __________________

Date                     Phone                                   

Email__________________________________________

Volunteers, we depend upon you !  Circle your interest :

Refreshments     Registration      Scoring      Computer Operator       Awards Table      Running Event     Field Event      Anything

_________________________________________

Volunteer  Name

Friday (pm)

Saturday (am)

Saturday (pm)