ATHLETE'S NAME:  AGE:

GENDER:

ADDRESS:  

                   

CITY:STATE:

                   

PERSONAL RECORD (PR):

PHONE NUMBER: 

EMAIL ADDRESS: 

CAMP OR CLINIC ATTENDING:

RELEASE OF CLAIMS

It is my understanding that there are certain risks involved with participating in the pole vault.

In recognition of the possible dangers connected with pole vaulting and any physical activity, I hereby knowingly and voluntarily waive any right of cause of action of any kind whatsoever arising as the result of such activity, from which any liability may or could accrue to Morry Sanders, Steve Irwin, Arkansas Vault Club and it's officers, agents, employees, or instructors.

Make Check or Money Order payable to:

Arkansas Vault Club

149 River Road

Norman, AR  71960

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This form is for CAMPS and CLINICS only. No need to register for weekly sessions.

MaleFemale

By checking here I have read and agreed to the release of claims listed above.

As a parent of a minor, I agree to the release of claims given above.

Spring Clinic (March 21st 12pm-5pm)                                              
Spring Clinic (March 28th  12pm-5pm)
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Summer Camp (June 10,11,12)