NORTHWEST MISSOURI STATE UNIVERSITY TRACK ...
NORTHWEST MISSOURI STATE UNIVERSITY TRACK & FIELD CAMP @ PLATTE COUNTY HIGH SCHOOL JUNE 20, 2015 9:00am-3:30pm Cost: $25 (lunch provided) Our 2015 track and field camp welcomes middle and high school athletes ages 10-18 looking to improve and grow in the sport of track and field. There are no specific performance requirements to attend our camp so athletes of all ability levels are encouraged to attend. Event opportunities are outlined below. Please note that athletes will have the opportunity to cross over into other events! Sprint Group: 100m, 200m, 400m Hurdles: 100mH, 110mHH, 300mH, Jumps: Long Jump, Triple Jump, High Jump, Pole Vault Distance: 800m, Mile/1500m, 3000/3200m Throws: Javelin, Shot Put, Discus (throwing implements will be provided) *ATTENTION POLE VAULTERS: Vaulters are required to bring their own poles.
REGISTRATION FORM Name:
Grade Next Fall:
Street Address: City:
State:
Home Phone:
Cell Phone:
Zip:
E-Mail address: Emergency Contact:
Work Phone: MEDICAL RELEASE APPROVAL
Past Health Issues: Past Injuries: Allergies: Present Medications: Insurance Company:
Policy Number:
Policy Holder: Insurance Company Address: I verify that my child has been checked by a licensed physician and is physically able to participate in the Northwest Missouri State University Track & Field Camp. I hereby agree that I will not hold Northwest Missouri State University or Platte County High School or its employees responsible for any loss, damages, or person injury receivedas a result of participation. I hereby authorize Scott Lorek or Emily Peterson to act for my child according to their best judge ment in an emergency requiring medical attention. This camp is not an official function of Northwest Missouri State University or Platte County High School.
Parent/Guardian Signature:
Date:
*Proof of insurance is required at time of check-in or can be faxed to (660)562-1493. Attention to Emily Peterson.
REGISTRATION FORM Name:
Grade Next Fall:
Street Address: City:
State:
Home Phone:
Cell Phone:
Zip:
E-Mail address: Emergency Contact:
Work Phone: MEDICAL RELEASE APPROVAL
Past Health Issues: Past Injuries: Allergies: Present Medications: Insurance Company:
Policy Number:
Policy Holder: Insurance Company Address: I verify that my child has been checked by a licensed physician and is physically able to participate in the Northwest Missouri State University Track & Field Camp. I hereby agree that I will not hold Northwest Missouri State University or Platte County High School or its employees responsible for any loss, damages, or person injury receivedas a result of participation. I hereby authorize Scott Lorek or Emily Peterson to act for my child according to their best judge ment in an emergency requiring medical attention. This camp is not an official function of Northwest Missouri State University or Platte County High School.
Parent/Guardian Signature:
Date:
*Proof of insurance is required at time of check-in or can be faxed to (660)562-1493. Attention to Emily Peterson.
