DEADLINE IS APRIL 18TH – NO EXCEPTIONS!
S.H.A.A. Track and Field 2013 Registration Form
And
PARENTAL PERMISSION AND CONSENT TO TREAT
Participant's Name: ___________________________________________________________ Grade _____
Parent /Guardian's Name:
_______________________________________________________________
Address______________________________________________________________, PA _____________
Home Phone: ___________ Cell Phone: ______________ Email: _________________________________
Parent/Guardian's Name:
________________________________________________________________
Address_________________________________________________________________, PA ___________
Home Phone: ___________ Cell Phone: ______________ Email: __________________________________
T-shirt size:
Youth YM ( ) YL ( ) Adult AS ( ) AM ( ) AL ( ) AXL ( )
Fee - $5.00
**** Make checks payable to SHAA ****
Medical Information:
Family Doctor: ___________________________________________ Phone number ___________________
Physical Limitations ______________________________________________________________________
Allergies _____________________ Asthma _____________________ Medications ___________________
Medical Insurance through the family:
Yes ____________
No ____________
Emergency Contact Information:
Name ______________________________________ Relation _________________ Phone ____________
Name ______________________________________ Relation _________________ Phone ____________
Parental Consent:
___________________________ has my permission to participate in the Sacred Heart Track and Field
program including the Knights of Columbus Track Meet. For your acceptance of my enrollment, I, the player,
and we, the parents individually and collectively, intending to be legally bound, hereby for ourselves and our
heirs, executors and administrators, wave and release the Sacred Heart Athletic Association, their agents and
representatives, from any and all claims or rights to damages for injuries or losses suffered by me, the player,
directly or indirectly, In training for, or travelling to or from, or competing in or while attending any future Athletic
Association functions. I acknowledge the registration fee does not include primary medical insurance
coverage. I consent to medical treatment for my child in an emergency.
Printed Parent Name: ______________________________________________________________
Parent Signature: ____________________________________________________ Date: _______________
S.H.A.A. Track and Field 2013 Schedule
5th – 8th Grade
Track and Field Practices at Buchanan Park (transportation on your own)
Sunday, April 21
2:00 - 3:30
Sunday, April 28
2:00 - 3:30
Track and Field Practices at Buchanan Park (will walk from school with coaches – pick up at the Park)
Thursday, April 25 3:00 – 4:30
Thursday, May 2
3:00 – 4:30
** We understand there will be conflicts with other activities – please attend we you can
Knights of Columbus Track Meet at LCHS (transportation on your own)
Sunday, May 5, 2013 1:00 - 5:00 PM - warm-up begins at 12:00
Girls Events:
Boys Events:
Standing broad jump
Standing broad jump
Frisbee throw
Football throw
Softball Throw
Softball Throw
50 meter dash
50 meter dash
75 meter dash
75 meter dash
400 meter run
400 meter run
800 meter run
800 meter run
400 meter relay
400 meter relay
800 meter relay
800 meter relay
Participates may compete in any 2 individual running events, plus 1 relay event, and all 3 field events, for a
total of 6 events for each participant.