Fly Higher Together with NHG’s
INDEPENDENCE DAY VAULT
DATE: Saturday, July 6, 2019
TENTATIVE SCHEDULE: 11:00 AM warm-ups for those coming in below 10’
3:00 PM warm-ups for those coming in between 10’&13’
6:00 PM warm-ups for those coming in above 13’
LOCATION: New Heights Gym
1204 Import Drive
New Iberia, LA 70560
Phone: 337-365-3806 Fax: 337-367-0652
Website: www.newheightsgym.org
Email: leleux@mindspring.com
DIRECTOR: Shane LeLeux 337-359-7314
ENTRY FEE: $40 per vaulter (free spectator admission)
Mail Entries to: New Heights Gym
P.O. Box 9838
New Iberia, LA 70562-9838
CONCESSIONS: It’s Cajun Pot Luck Style, we won’t sell concessions, but we encourage you to bring food to share, we will have Bar-B-Q pits set up to cook, bring your own drinks and ice chest, don’t forget your chairs.
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This event is sanctioned by USATF
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All participants must have a current USATF membership.
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USATF membership must be obtained before the competition begins except where the event operator has a laptop available with an internet connect.
INDEPENDENCE DAY VAULT
REGISTRATION FORM
Name: ______________________________ Gender: M / F Age: _____ Phone: ___________________
Address: ____________________________________________ Email: _____________________________
USATF /AAU #: _______________ Club Affiliation: ______________________________ PR: __________
Division (circle one): Youth (13 – 14) Girl / Boy Intermediate (15 – 16) Girl / Boy
Young (17 – 18) Women / Men Open Adult (19 – 29) Women / Men
Masters (30 +) Women / Men Open Youth (12 & Under) Girl / Boy
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 and right of cause of action of any kind whatsoever arising as a result of such activity, from which any liability may or could accrue to Shane LeLeux, Bridget LeLeux, New Heights Gym, and its officers, agents, employees, or instructors.
If under eighteen (18) years of age, parent or legal guardian must sign.
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Print Name of Athlete Signature of Athlete Date
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Print Name of Parent/ Guardian Signature of Parent/ Guardian Date
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This event is sanctioned by USATF
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All participants must have a current USATF membership.
-
USATF membership must be obtained before the competition begins except where the event operator has a laptop available with an internet connect.
Mail Completed Entry Form, USATF membership number, and Release with Entry Fee to:
New Heights Gym
P.O. Box 9838
New Iberia, LA 70562