wad 2012 Survey

Please provide accurate personal information:

Last Name:

Middle Name:

First Name:

SEX:

AGE:

DATE OF BIRTH (D/M/Y)

CLUB:

SCHOOL:

ISLAND:

EVENT #1:

EVENT #2:

EVENT #3:

EVENT #4:

EVENT #5:

EVENT #6:

EVENT#7:

FEDERATION REGISTRATION #:

COMPETITION #(TO BE PROVIDED):

I will compete in the Kids Track and Field (Athletics) [If yes place X here :

YOUR COACH/S NAME:

Release--Waiver--Statement of Fitness
I entering this competition, hereby atest that I have trained for and am in proper physical and mental condition as ascertained by a licensd physician, to compete in track and field events that I have entered in high heat and humidity on the track designated. I further release all sponsors and volunteers, organizers and the Government of the Virgin Islands from all claims resulting from loss, injury or illness resulting from my participation in this competition and give permisson to use my name and/or image n any account of this competition.

Place your name (signature) in the box:
(if you are under the age of 18 your parent/guardian must place their name (signature) in the box:

To register with the VITFF logon to: http://virginislandspace.org

This event is hosted by:
The Virgin Islands Track and Field Federation:
http://virginislandstrackandfield.org
P.O. Box 222720 Christiansted, St. Croix,
Virgin Islands 00822

Organized by:
The St. Croix Track Club:
http://www.eteamz.com/stxtc/
The Virgin Islands Pace Runners:
http://virginislandspace.org