First Name:
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Middle Name:
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Last Name:
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Weight:
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Birthday:
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Age:
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Male or Female:
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Shirt Size:
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Address:
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City:
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State:
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Zip
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Contact Number:
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Cell Number:
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Email:
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Current School Name:
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Year in School:
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Coaches Name:
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Times and Events:
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Do you have Medical Insurance?
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Medical Conditions: (will expand)
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Providers Name:
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Group Number:
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CoPay:
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Will you register for the Pole Vault Camp?
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Sundays Oct 1st to 13th Oct 1st 9th 16th 13th
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Sundays Oct 1st to 13th TIME SLOT
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Sundays Oct 30th to Nov 30th Oct 30th Nov 6th 13th 30th
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Sundays Oct30th to Nov 30th TIME SLOT
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Sundays Nov 27th to Dec 18th Nov 27th Dec 4th 11th 18th
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Sundays Nov 27th to Dec TIME SLOT
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Sundays Jan 8th to 29th Jan 8th 15th 22nd 29th
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Sundays Jan 8th to 29th TIME SLOT
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Sundays Feb 5th to 26th Feb 5th 12th 19th 26th
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Sundays Feb 5th to 26th TIME SLOT
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Mondays Oct 10th to 31st Mon Oct 10th 17th 24th 31st
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Mondays Oct 10th to 31st TIME SLOT
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Mondays Nov 7th to 28th Nov 7th 14th 21st 28th
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Mondays Nov 7th to 28th TIME SLOT
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Mondays Dec 5th to Jan 2nd Dec 5th 12th 19th Jan 2nd
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Mondays Dec 5th to Jan 2nd TIME SLOT
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Mondays Jan 9th to 30th Jan 9th 16th 23rd 30th
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Mondays Jan 9th to 30th TIME SLOT
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Mondays Feb 6th to 27th Feb 6th 13th 20th 27th
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Mondays Feb 6th to 27th TIME SLOT
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Wednesdays Oct 5th to 26th Oct 5th 12th 19th 26th
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Wednesdays Oct 5th to 26th TIME SLOT
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Wednesdays Nov 2nd to 23rd Nov 2nd 9th 16th 23rd
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Wednesdays Nov 2nd to 23rd TIME SLOT
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Wednesdays Nov 30th to Dec 21st Nov 30th Dec 7th 14th 21st
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Wednesdays Nov 30th to Dec 21st TIME SLOT
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Wednesdays Jan 4th to 25th Jan 4th 11th 18th 25th
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Wednesdays Jan 4th to 25th TIME SLOT
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Wednesdays Feb 1st to 22nd Feb 1st 8th 15th 22nd
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Wednesdays Feb 1st to 22nd TIME SLOT
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Add Master Vaulters Session Thursdays Only 6pm to 8pm?
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Master Vaulters Dates
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Sign up for Elite Pole Vault Camp?
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Elite Camp Mondays 5pm to 7pm Only
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Elite Camp Wednesdays 5pm to 7pm Only
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Elite Camp Thurs Sept 29th to Oct 20th Sept 29th Oct 6th 13th 20th
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Elite Camp Thurs Sept 29th to Oct 20th TIME SLOT
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Elite Camp Thurs Oct 27th to Nov 17th Oct 27th Nov 3rd 10th 17th
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Elite Camp Thurs Oct 27th to Nov 17th TIME SLOT
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Elite Camp Thurs Dec 1st to 22nd Dec 1st 8th 15th 22nd
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Elite Camp Thurs Dec 1st to 22nd TIME SLOT
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Elite Camp Thurs Jan 5th to 26th Jan 5th 12th 19th 26th
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Elite Camp Thurs Jan 5th to 26th TIME SLOT
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Elite Camp Thurs Feb 2nd to 23rd Feb 2nd 9th 16th 23rd
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Elite Camp Thurs Feb 2nd to 23rd TIME SLOT
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Elite Camp Fridays 5pm to 7pm Only
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Do you want Elite Fridays in February also?
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Would you like to sign up for High Jump?
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High Jump Sessions Sundays 115pm to 315pm ONLY
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Would you like to sign up for Long Jump/Triple Jump?
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Long/Triple Jump Sundays Nov - Dec Nov 27th Dec 4th 11th 18th
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Long/Triple Jump Nov 27th to Dec 18th TIME SLOT
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Long/Triple Jump Sundays January Jan 8th 15th 22nd 29th
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Long/Triple Jump Jan 8th to 29th TIME SLOT
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Long/Triple Jump Sundays February Feb 5th 12th 19th 26th
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Long/Triple Jump Feb 5th to 26th TIME SLOT
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Would you like to sign up for the Youth Track Program?
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Youth Track Program Saturdays Only 10am to 12 noon
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Do you want to add Speed Training?
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What days do you want for this?
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What times for the Speed Training?
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I agree to pay in full for the items I have registered for and sign and turn in all required forms before or on the day of the camps. Yes I agree
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Electronic Signature
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Date Signed
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