Contact

1204 Import Drive

New Iberia, LA 70560

​​

Tel: 337-365-3806

Email: leleux@mindspring.com

Website: www.newheightsgym.org

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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.

 

  • This event is sanctioned by USATF

  • 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.

 

 

                                                                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.

 

____________________________________________________________________________________________

Print Name of Athlete                                            Signature of Athlete                                         Date

 

 

____________________________________________________________________________________________

Print Name of Parent/ Guardian                      Signature of Parent/ Guardian                           Date

  • This event is sanctioned by USATF

  • 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