ROSELAND RECREATION DEPARTMENT
973/403-6822 mcolitti@roselandnj.org
Mayor John Duthie
2014 JR. OLYMPICS
The JUNIOR OLYMPICS is a track and field competition for Roseland resident children ages 5 through 12 (as of
June 20th). Each participant may enter up to 4 events. Awards will be presented to all 1 st, 2nd, and 3rd place winners in
each event and overall in each age category. NO CLEATS - SNEAKERS ONLY!
Age Groups:
Date:
Where:
Check in:
5-6, 7-8, 9-10 and 11-12 (Boys and Girls are separated for events)
Friday, June 20, 2014
O’Beirne and Harrison Fields from 6:00 p.m. – 9:00 p.m. (Includes Awards)
5:30 p.m. – 6:00 p.m. (Numbers will be distributed at that time)
*Important: Please note the events you have selected (below) for your records:
Field Events: Shot Put __, Running Long Jump __, and Softball Throw__
Track Events: 50 yd. dash __, 110 yd. dash __, 220 yd. dash __, 440 yd. dash __ and Steeple Chase__
In case of inclement weather call 973/226-6552 opt. #3 - no earlier than two hours before the event.
Please return complete form no later than Thursday, June 19, 2014. (NO SAME DAY SIGNUPS)
Mail to or drop off to: Roseland Recreation 140 Eagle Rock Avenue Roseland, NJ 07068
(Detach Here)
-------------------------------------------------------------------------------------------------------------One form per participant
2014 Junior Olympics
Participant Number ________
(Office use only)
NAME ____________________________________ E-MAIL ADDRESS ________________________________
ADDRESS _______________________________________ TOWN/CITY __________STATE___ ZIP________
HOME PHONE ____________________________ EMERGENCY PHONE ________________________________
EMAIL________________________________ AGE _____ BIRTH DATE _____________ SEX: M____ F ____
A Child May Only Enter Up To 4 Events
Field Events (6:00 p.m.-7:30 p.m.)
Running Long Jump (all ages) ______
Shot Putt (all ages)
______
Softball Throw (all ages)
Track Events (7:30 p.m. - 9:00 p.m.)
50 Yard Dash (all ages)
______
110 Yard Dash (ages 5-6)
______
220 Yard Dash (ages 7-8)
______
220 Yard Dash (ages 9-10)
______
440 Yard Dash (ages 11-12) ______
Steeple Chase (ages 7-8)
Steeple Chase (ages 9-10)
Steeple Chase (ages 11-12) ______
In consideration of this entry being accepted, I hereby for myself, heirs, executors and administrators, waive and release any and all claims that I
may have against The Roseland Recreation Department, The Roseland Board of Education, The Roseland Police and First Aid Squads, or those
representatives, successors, assignees and any other sponsors of this event (hereafter to be known as the Group), for any injuries that may be
suffered by me in this event. It is also understood by me that the Group provides no insurance coverage for this event and I attest that I am in
physical condition for this event. I also understand that I will not hold the group responsible for any publicity used concerning this event and that
entry fees are non-refundable.
NOTICE- Any written statement made on this from, which the writer knows to be false or one which the writer does not believe to be true, is punishable
under New Jersey law as a crime of the fourth degree (2C-28-3).
Child Photo / Video / Release Form
I grant permission for the Borough of Roseland, Roseland, New Jersey to use photograph(s)/moving image(s) of my child participating in Borough
programs and/or activities for promotional purposes. I understand that photographs or recordings may be utilized by the Borough at its discretion
for materials including, but not limited to: newsletters, brochures, television, video tape and flyers. Photographs sent to the local
newspaper may have names noted. There will be no valuable consideration paid as a result of this activity. Yes ___
No ___
Parent’s/Guardian’s Signature ______________________________________
(I have read and understood all event information)
Date ______________
For information on all Recreation Programs use Channel 35 or Verizon 46, www.roselandnj.org, or look in “The Progress” newspaper.