Landon Athletics

Barry County Fair Vault

Entry Form

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Name (please print)	Phone

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Address

City, State, Zip

Email	___________________	Your Age________________

Age Division ____________________	Gender_________

Best Height in Competition	_________________________

Possible Starting height for you ________________

Medical Release I hereby grant my child permission to compete in the Barry County Fair Vault competition. I verify that my child has had a physical exam in the past year and is capable to participate in the activities related to the competition. I agree to indemnify, hold harmless and defend Jerry Sessions, Barry County Expo and/or their employees from any liability for injury to my child, as well as any injury caused by my child. I also hereby grant permission to Landon Athletics to use any photography and videotape of myself and/or child related to Barry County Fair Expo activities for advertising or educational video materials.

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Competitor’s Signature	Date

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Parent’s Signature	Date

Sanctioned by the USATF

Entry Fee	$30.00	($40.00 Day of Event)

Gate Charge will be reimbursed to participating vaulters

Make all checks payable to:

Landon Athletics, LLC

PO Box 538

450 E Casgrove St.

Nashville MI 4907