Registration- 2007 Clinics

Your Choice: Print the form below or download it here.
Mail or bring it with your registration fee to the clinic

ATHLETE REGISTRATION

Circle Clinic Session: Session 1 (June 5 -June 7) Session 2 (June 11 -June 13)

Name: ___________________________________________

Date of Birth: ___________________________________________

Club/School Name: ___________________________________________

Division: Midget Youth Intermediate Senior

Hurdle Event(s) and Best Time(s) ___________________________________________

Coach's Name ___________________________________________

Parent's Name ___________________________________________

Home Address ___________________________________________

City ____________________________ State _______________ Zip _________

Phone _____________________________ Alt. Phone ___________________________

Email Address: ___________________________________________



COACH'S REGISTRATION

Name: ___________________________________________

Club/School Name: ___________________________________________

Home Address ___________________________________________

City ____________________________ State _______________ Zip _________

Phone _____________________________ Alt. Phone ___________________________

USATF Coach's Certification Level: ___________________________

Email Address: ___________________________________________



Release

I hereby authorize the directors of the Hurdles Are Fun-D-Mental Clinic to act for me according to their best judgment in any emergency requiring medical attention. I know of no mental or physical problems which might affect me as a participant or my son's/daughter's ability to safely participate in this clinic. Furthermore, we (I) certify that within the past year my child has had a physical examination and is physically able to participate in sports activities. I will be responsible for any medical or other charges in connection with my, his/her attendance at the clinic. I hereby release and hold harmless the sponsors, promoters, and all other persons and entities associated with this clinic including, but not limited to, Andrew Blanks, Joy Kamani, the clinic staff, and Westbury High School from any and all liability claims, demands, actions and causes of action whatsoever arising out of or related to any loss, personal injury or property damage that may be sustained or occur during the participation of clinic activities while at the clinic.

Parent's Signature: ___________________________ Date _______________________

For Office Use Only:
Check # ________ Amt.: ________ or Cash Amt. ____________ Date: ____________

Please make your checks payable to: Joy Kamani
Mail Registration Form with payment to:
Joy Kamani
Hurdles Are Fun-Da-Mental
1326 Tiny Tree Dr.
Missouri City, TX 77489

or Fax Form to 831-855-8290 and bring payment to Clinic Registration on first day of session.