Invitational. Dame Group & Boss Barbell Club Presents

Size: px
Start display at page:

Download "Invitational. Dame Group & Boss Barbell Club Presents"

Transcription

1 Invitational Dame Group & Boss Barbell Club Presents Open Powerlifting Meet (Raw and Classic Raw) FULL POWER ONLY Limited to the FIRST 90 REGISTERED LIFTERS MUST BE INVITED OR HAVE A CLASS 1 TOTAL TO COMPETE THIS DAY DATE & TIME: Saturday, August 29, 2015, 9:00 AM LOCATION: Mountain View Sports Pavilion, 1185 Castro Street, Mountain View, CA DIRECTIONS: SANCTIONED BY: ELIGIBILITY: DIVISIONS: Use Google Maps or GPS from your location. United States Powerlifting Association (USPA) Must be invited or have Class 1 total in order to compete in this event. Any male or female age 18 years or older. Lifters must be current USPA members. Memberships are $40 for adults. Good for one year from date of purchase. Must purchase online at Open only WEIGHT CLASSES: Men: 114, 123, 132, 148, 165, 181, 198, 220, 242, 275, 308, 308+ Women: 97, 105, 114, 123, 132, 148, 165, 181, 198, 198+ RULES: One-piece type singlet must be worn as a minimum. Raw division: allows one piece singlet, 4 inch belt-(must be buckle or lever with no padding on the inside of belt), wristwraps, and kneesleeves. Classic Raw division: allows kneewraps in the squat with everything else being raw. All lifters must wear over the calf socks in the deadlift. SCHEDULE: (All Lifters) AWARDS: Early Weigh-in/gear check for Saturday lifters:------friday, 9am to 11am and 5:30pm to 7:30pm Same day Weigh-in/gear check: **must request in advance for same day weigh in Rules Briefing/Warmup: Saturday, 8:00am Lifting Begins: Saturday, 9:00am Open st - 3 rd place in each weight class Cash awards for: Best overall (male classic raw) Best overall (male raw) Best overall (women classic raw) Best overall (women raw) 2nd Best overall (male classic raw) 2nd Best overall (male raw) 2nd Best overall (women classic raw) 2nd Best overall (all women raw) 3rd Best overall (male classic raw) 3rd Best overall (male raw) 3rd Best overall (women classic raw) 3rd Best overall (all women raw) **ALL awards for BOTH days (Saturday & Sunday) will be given out at Sunday s banquet** (If you are unable to attend the banquet, you may choose to have your award mailed to you or can pick up at Boss Barbell the following week at no extra charge. ENTRY FEE: $ per lifter, add $35 if entering additional event or division (PL & BP=2 awards or Open & Master=2 awards) Separate Team entry fee-$35.00 Individual entry required. DEADLINE: Entries must be mailed by July 2, Entries mailed after deadline must pay late fee of $20. No entries accepted on day of contest. Limited to first 90 lifters PAYMENT: QUESTIONS: Make check or money order payable to: Boss Barbell Send entry form and payment to: Boss Barbell 241 Polaris Ave, Mountain View, California ONLY CHECK, MONEY ORDER OR CASHIER S CHECK will be accepted. Call Boss Barbell at or at info@bossbarbell.com

2 WEBSITE: ACCOMODATIONS: Events: You may go to to print additional copies of the entry form or to view the California State and American records and USPA rules. Coming soon! Friday August 28 th is the Meet THE BOSSES Press conference 6:30pm at Boss Barbell Club, 241 Polaris Ave, Mountain View CA The Meet The BOSSES Press Conference is going to be Friday evening August 28 th. Team AnimalPak and selected World Class lifters will all be at this conference to answer all of your questions, hand out some personal swag and take pictures before they hit the platform on Saturday. This is a great opportunity for you to meet your favorite powerlifters and to get some advice/tips from the professionals. Seating is limited! The rate is discounted for those who register in advance. **Early bird special.** Sunday August 30 th is the Boss of Bosses II Awards Banquet (around 5:30pm). The awards banquet is Sunday August 30 th following the meet. Come support your fellow competitors and hang out with THE BOSSES. Legendary Ed Coan will be handing out the awards to the all lifters and will be available for pictures and autographs. ALL awards for BOTH days (Saturday & Sunday) will be given out at the banquet (If you are unable to attend the banquet, you may choose to have your award mailed to you ($8 flat rate within the USA) or you can pick up at Boss Barbell the following week at no extra charge, by appointment. The banquet is also limited seating. Anyone can attend the banquet, but lifters receive priority if booked in advance. We will serve a 3-course meal and will have great entertainment (he goes by the name POOTIE). Additional information: What is the meet shirt? What is the meet prep t-shirt? The meet shirt is the shirt we are selling at the meet. Most people buy this shirt as a souvenir shirt. This shirt will be available for anyone to purchase. The meet prep shirt is the shirt we will mail to you after registering for the meet (if purchased). This shirt has secret BOSS power to help motivate you in your training while prepping for your #bossofbosses2 meet. Unfortunately during the meet, THE BOSSES will not be available for pictures, autographs or advice. The Meet the BOSSES press conference is a good time for this, but not at the meet. Please respect their privacy. We will notify everyone who has registered via . If you have not received an within 3 weeks after you have mailed in your registration, please give us a call or us info@bossbarbell.com. You are not registered until you have received a confirmation . The meet will be held at The Mountain View Sports Pavilion, 1185 Castro Street, Mountain View, CA DO NOT SEND your entry forms there. Send your entry form to Boss Barbell, 241 Polaris Ave, Mountain View, CA Weigh-in for Saturday lifters ONLY will also be at Boss Barbell.

3 Entry form for SATURDAY lifters competing August 29 th 2015 Please mail your entry form, waiver and payment to: Boss Barbell Club, 241 Polaris Ave, Mountain View, California Name: Age on Aug 30 th : Birth date: / / Address: Apt #: City: State: Zip: Country: Phone # ( ) - (required): Qualifying total in what weight class & gear division: Are you a current USPA member (circle): Yes No If yes, date of purchase: (Memberships must be purchased online at Check the type of gear divison you will compete in, pick only one (add additional divisions below): Raw Full Power PL [ ] Classic Raw Full Power PL [ ] Circle the weight class you are entering Men s Weight Classes: Women s Weight Classes: Circle the Division you are entering 114LB 123LB 132LB 148LB 165LB 181LB 198LB 220LB 242LB 275LB 308LB 308+LB 97LB 105LB 114LB 123LB 132LB 148LB 165LB 181LB 198LB 198+LB POWERLIFTING (Full meet): Open, Junior 13-15, 16-17, 18-19, 20-23, Submaster 35-39, Master 40-44, 45-49, 50-54, 55-59, 60-64, 65-69, 70-74, 75-79, 80+ *The entry fee is the ONLY required fee. Everything else is optional. Please keep in mind that the prices listed below are discounted as early bird specials. All items will increase after a certain time period. Entry fee $115: $ Banquet $15 ($25 non-lifters) $ Additional division $35: $ event: Meet the Bosses $30 $ Team entry $35: $ LATE FEE $20 $ Meet shirt $20 ($30 day of meet) $ size: Meet prep shirt $15 $ size: Notes: TOTAL $ Cash [ ] Check [ ] Money Order [ ] Cashier s Check [ ] Received by: Date:

4 RELEASE OF LIABILITY -- READ BEFORE SIGNING and return with entry form and fee In consideration of being allowed to participate in any way in the Boss of Bosses II Open Powerlifting meet sanctioned by the USPA, its related events and activities, I,, the undersigned, acknowledge, appreciate, and agree that: 1. The risk of injury from the activities involved in this program is significant, including the potential for permanent paralysis and death, and while particular skills, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and, 2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASES or others, and assume full responsibility for my participation; and, 3. I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the USPA officials immediately; and, 4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS THE Meet Director/promoter, USPA, Dan Green, Sparkle Green, Boss Barbell Club, Mountain View Sports Pavilion, and their officers, officials, agents and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessors of premises used for the activity ("Releasees"), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law. I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. x Age: Date Signed: PARTICIPANT'S SIGNATURE FOR PARENTS/GUARDIANS OF PARTICIPANTS OF MINORITY AGE (UNDER AGE 18 AT TIME OF REGISTRATION) This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her release as provided above of all the Releasees, and, for myself, my heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the Releasees from any and all liabilities incident to my minor child's involvement or participation in these programs as provided above, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES, to the fullest extent permitted by law. x PARENT/GUARDIAN'S SIGNATURE EMERG. PHONE # (s) : Date Signed

5 USPA Official Team Entry Form Name of Team: Date of meet WT Class Lifters Wilks Points Team Entry must be submitted to Scorekeeper before Lifting starts. No changes thereafter. Lifters can be from any division, male and female. Separate team entry forms should be submitted for full power, bench only, and deadlift only teams. No more than 12 Lifters per team and no more than 2 lifters in each Weight Class. A minimum of six lifters must be submitted to establish a team. If a team submits 12 lifters, the top six lifters from that team will be scored using the Wilks formula then those numbers will be added together to create the Final Wilks Team Score. No age formula will be used to determine final Wilks scoring. The women's 97,105, and 198+ wt classes can be substituted in. Team entry fee: $35

Taishi Judo Club 5 th Annual Invitational Tournament

Taishi Judo Club 5 th Annual Invitational Tournament Taishi Judo Club 5 th Annual Invitational Tournament Date/Time: Location: Sunday, March 22, 2015. Tournament will start promptly at 10:00AM Northview High School 1016 W. Cypress St. Covina, CA 91722 Sanction:

More information

IMPORTANT NOTICE EACH TEAM APPLYING FOR COVERAGE MUST BE A MEMBER OF AMERICAN YOUTH SPORTS ATHLETIC ASSOCIATION

IMPORTANT NOTICE EACH TEAM APPLYING FOR COVERAGE MUST BE A MEMBER OF AMERICAN YOUTH SPORTS ATHLETIC ASSOCIATION IMPORTANT NOTICE EACH TEAM APPLYING FOR COVERAGE MUST BE A MEMBER OF AMERICAN YOUTH SPORTS ATHLETIC ASSOCIATION TO BE ELIGIBLE FOR THE INSURANCE RATES ON THE FOLLOWING PAGE For fast service fax completed

More information

Barstow Judo Club Invitational Judo Tournament

Barstow Judo Club Invitational Judo Tournament Barstow Judo Club Invitational Judo Tournament Date: Sunday June 24, 2012 Location: Eligibility: Entry Fee: Awards: Sanction: Cora Harper Community Center 841 Barstow Road Barstow, CA 92311 MUST BE Current

More information

2013 Mid-West Collegiate Championships February 9, 2013

2013 Mid-West Collegiate Championships February 9, 2013 2013 Mid-West Collegiate Championships February 9, 2013 Host: Purdue Judo Club Location: Purdue University Sanction: USA Judo Recreational Sports Center Indiana Judo Inc. 355 N. Martin Jischke Drive West

More information

Taishi Judo Club 5 th Anniversary Invitational Tournament

Taishi Judo Club 5 th Anniversary Invitational Tournament Taishi Judo Club 5 th Anniversary Invitational Tournament Date: Sunday, February 21, 2016. Time: Location: Tournament will start promptly at 10:00AM Cerritos College 11110 Alondra Boulevard Norwalk, CA

More information

American Football Association, Inc. Endorsed General Liability Insurance Program Available: January 1, 2015 to January 1, 2016

American Football Association, Inc. Endorsed General Liability Insurance Program Available: January 1, 2015 to January 1, 2016 American Football Association, Inc. Endorsed General Liability Insurance Program Available: January 1, 2015 to January 1, 2016 This insurance program is available for amateur teams & leagues that are members

More information

The Ruben Martin Open Judo Championships

The Ruben Martin Open Judo Championships The Ruben Martin Open Judo Championships Sponsored by: ROUND ROBIN FOR DIVISIONS OF 5 OR LESS TRUE DOUBLE ELIMINATION FOR 6 OR MORE AT LEAST 3 MATCHES FOR MOST JUNIORS JUNIOR NOVICE DIVISIONS (up to one

More information

2016 Texas Judo Inc. NCJA Southwest Regional Collegiate Championships

2016 Texas Judo Inc. NCJA Southwest Regional Collegiate Championships HOST: ELIGIBILITY: Texas A&M University Judo Team http://aggiejudo.com Texas, Oklahoma, Louisiana, Arkansas, Mississippi & New Mexico full time college students. See eligibility requirements on page 3

More information

K I D S C A M P 2 0 1 4

K I D S C A M P 2 0 1 4 K I D S C A M P 2 0 1 4 June 9-12 8 a.m. 4 p.m. Grades 3-12 Fee: $50 Join us for a fun-filled learning experience! For an application packet Please stop by the Ben Hill-Irwin Campus at 667 Perry House

More information

Tech Judo Open II Invitational Judo Tournament

Tech Judo Open II Invitational Judo Tournament Tech Judo Open II Invitational Judo Tournament USA Judo Sanction # 2015-12-02 Date: Sunday, February 15, 2015 Tournament Director: Clyde Worthen Tournament Coordinator: Leonardo Victoria Head Referee:

More information

without a signed waiver Santa Fe, NM 87506 Fax: 505 820 Student Name: City: Zip: State: Physician's Name: Parent Name(s): Parent Address: City:

without a signed waiver Santa Fe, NM 87506 Fax: 505 820 Student Name: City: Zip: State: Physician's Name: Parent Name(s): Parent Address: City: Please mail application to: Las Campanas Compadres, Inc. 15 Buckskin Circle Santa Fe, NM 87506 Fax: 505 820 2709 Las Campanas Compadres, Inc. Student Application Form Please be sure to sign the waiver

More information

Mission Statement. Participant Guidelines

Mission Statement. Participant Guidelines Mission Statement The Hoover Boxing Program's mission is to provide Hoover Middle School students a structured and positive environment where kids can remain active and safe during unstructured hours such

More information

50th Annual Dallas Invitational Judo Championships

50th Annual Dallas Invitational Judo Championships 50th Annual Dallas Invitational Judo Championships Sponsored by: ROUND ROBIN FOR DIVISIONS OF 5 OR LESS TRUE DOUBLE ELIMINATION FOR 6 OR MORE AT LEAST 3 MATCHES FOR MOST JUNIORS JUNIOR NOVICE DIVISIONS

More information

Cherry Blossom Open XXII

Cherry Blossom Open XXII Cherry Blossom Open XXII Saturday, February 13, 2016 National Ranking Points: Bantam, Intermediate, & Juvenile A & B only - 2 for 1st, 1 for 2nd, and.5 for 3rd Hosted by: Tomodachi Judo Club & Ki-Itsu-Sai

More information

2015 Tournament Entry Form

2015 Tournament Entry Form Mississippi MS HIGH SCHOOL BASS NATION 2015 Tournament Entry Form ONE FORM PER TEAM Angler #1 Name: Event Location: Angler #2 Name: School Club Name: Team Advisor Name: Ph# Address: City: State: Zip Code:

More information

Minnesota State Open Judo Championship Saturday May 2, 2009 (USJI Sanction JMI #0902)

Minnesota State Open Judo Championship Saturday May 2, 2009 (USJI Sanction JMI #0902) Minnesota State Open Judo Championship Saturday May 2, 2009 (USJI Sanction JMI #0902) SCHEDULE OF EVENTS A LOCATION s Friday, May 1, 2009 (Midway Judo Club) 6:00 PM 8:00 PM Referee s Clinic ($10.00 fee

More information

Release of Liability. Printed Name of Participant:

Release of Liability. Printed Name of Participant: Release of Liability IN CONSIDERATION of being given the opportunity to participate in any USRowing activity, including scheduled, supervised club activities, and registered regattas, during the policy

More information

2014 NIKKEI GAMES JUDO SHIAI & KATA TOURNAMENT Sponsored by the Nikkei Games Coordinating Council

2014 NIKKEI GAMES JUDO SHIAI & KATA TOURNAMENT Sponsored by the Nikkei Games Coordinating Council Date / Time: Sunday, August 10, 2014 / Kata Competition 9:00 AM - Shiai Competition 10:00 AM Location: Long Beach Pyramid-California State University, Long Beach 1250 Bellflower Blvd., Long Beach, CA 90840

More information

ABSOLUTELY NO ENTRIES WILL BE ACCEPTED IF POSTMARKED AFTER JULY 13, 2016.

ABSOLUTELY NO ENTRIES WILL BE ACCEPTED IF POSTMARKED AFTER JULY 13, 2016. 2016 NPC USA BODYBUILDING CHAMPIONSHIPS BODYBUILDING, FIGURE, BIKINI and PHYSIQUE CHAMPIONSHIPS Dear NPC Athlete: Please read the entire brochure thoroughly as it contains important information. Enclosed

More information

CHICAGO RUNNING TOURS & MORE, LLC WAIVER AND RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT PLEASE REVIEW THOROUGHLY BEFORE SIGNING

CHICAGO RUNNING TOURS & MORE, LLC WAIVER AND RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT PLEASE REVIEW THOROUGHLY BEFORE SIGNING CHICAGO RUNNING TOURS & MORE, LLC WAIVER AND RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT PLEASE REVIEW THOROUGHLY BEFORE SIGNING The undersigned, in consideration of being permitted to participate

More information

ARCADIA YOUTH RODEO ASSOCIATION, INC. 124 Heard Street, Arcadia, Florida 34266 863-494-2014 2015-2016 SEASON MEMBERSHIP APPLICATION

ARCADIA YOUTH RODEO ASSOCIATION, INC. 124 Heard Street, Arcadia, Florida 34266 863-494-2014 2015-2016 SEASON MEMBERSHIP APPLICATION 2015-2016 SEASON MEMBERSHIP APPLICATION MEMBER INFORMATION: BACK TAG # ISSUED: MEMBER NAME: ADDRESS: CITY: STATE: ZIP: HOME PHONE: CEL #: E-MAIL ADDRESS: (Please send newsletter via: Mail E-Mail ) DATE

More information

2015-16 Insurance Information Insurance coverage

2015-16 Insurance Information Insurance coverage 2015-16 Insurance Information Insurance coverage At USA Wrestling, our top priorities are safety and security. That's why we make sure you're covered by General Liability, Accidental Medical Expense, and

More information

SIXTY-SECOND ANNUAL PALO ALTO JUDO TOURNAMENT. Registration Information. Contest Information

SIXTY-SECOND ANNUAL PALO ALTO JUDO TOURNAMENT. Registration Information. Contest Information SIXTY-SECOND ANNUAL PALO ALTO JUDO TOURNAMENT The Sixty-second Palo Alto Judo Tournament will be held in Ayers Gym at Menlo-Atherton High School on Sunday, November 15, 2015. The school address is 555

More information

Emerald Hills Junior Golf Camp - Summer 2016. 938 WILMINGTON WAY REDWOOD CITY, CA 94062 www.playemeraldhills.com E-Mail - jrgolf.ehgc@gmail.

Emerald Hills Junior Golf Camp - Summer 2016. 938 WILMINGTON WAY REDWOOD CITY, CA 94062 www.playemeraldhills.com E-Mail - jrgolf.ehgc@gmail. OUR CAMPS ARE FOR GIRLS AND BOYS (AGES 5 THRU 14) Visit our website at Junior Golf Camp (9:00am 12:30pm) We start camp early (8:45am) on Monday for check-in and orientation. The camp is designed for beginners

More information

2015 RACE REGISTRATION packet

2015 RACE REGISTRATION packet 2015 RACE REGISTRATION packet First annual Delaware Charity Challenge Saturday, May 2, 2015 Lums Pond State Park Bear, Delaware delawarecharitychallenge.com Saturday, May 2, 2015 Lums Pond State Park 2015

More information

MEMBERSHIP/BOAT SUPPORT APPLICATION

MEMBERSHIP/BOAT SUPPORT APPLICATION MEMBERSHIP/BOAT SUPPORT APPLICATION Family memberships include no more than two adults per household and their unmarried rowing children under the age of 21 (or currently enrolled in school up to age 23).

More information

GATEWAY DISCOVERY CAMP

GATEWAY DISCOVERY CAMP GATEWAY DISCOVERY CAMP SUMMER 2 0 1 6 REGISTRATION FORM Gateway Science Museum will host three sessions of the Gateway Discovery Camp. All sessions run 9am to 3pm and include daily snacks and lunches.

More information

Midwest Cheer Elite All-star Hip Hop Information 2015-2016

Midwest Cheer Elite All-star Hip Hop Information 2015-2016 Midwest Cheer Elite All-star Hip Hop Information 2015-2016 Welcome to Midwest Cheer Elite, Inc. We are delighted that you have chosen to become a part of one of the top All-Star programs in the Midwest!

More information

Name Phone No. ( ) Address: City: State Zip. Age _ Height Expected Weight Hotel Stay

Name Phone No. ( ) Address: City: State Zip. Age _ Height Expected Weight Hotel Stay OFFICIAL USE ONLY OFFICIAL ENTRY FORM 2015 NPC KENTUCKY DERBY FESTIVAL FIGURE, BIKINI, BODYBUILDING, PHYSIQUE, FITNESS CHAMPIONSHIPS April 25, 2015 A NATIONAL QUALIFYING EVENT DIVISION CLASS WEIGHT NUMBER

More information

DATE OF BIRTH: STREET ADDRESS: CITY/STATE/ZIP:

DATE OF BIRTH: STREET ADDRESS: CITY/STATE/ZIP: Get Noticed Beach Volleyball Waiver WAIVER AND RELEASE, EXPRESS ASSUMPTION OF RISK, INDEMNITY AND HOLD HARMLESS AGREEMENT, AND GRANT OF RIGHTS NAME OF PLAYER: PLAYER AGE DATE OF BIRTH: PLAYER GRADE as

More information

The 2015 U.S. Open Veterans Judo Championships Fort Lauderdale, Florida Sponsored by A. Kolychkine Judo Foundation

The 2015 U.S. Open Veterans Judo Championships Fort Lauderdale, Florida Sponsored by A. Kolychkine Judo Foundation The 2015 U.S. Open Veterans Judo Championships Fort Lauderdale, Florida Sponsored by A. Kolychkine Judo Foundation Held under the Sanction (2014-04-07) of USA JUDO (United States Judo, Inc.) Domestic &

More information

LENS Program Checklist LENS Check performed by: (FOR OFFICE USE ONLY) Signature. LENS Check Results: (Please check one) ACCEPTABLE (5 or few points)

LENS Program Checklist LENS Check performed by: (FOR OFFICE USE ONLY) Signature. LENS Check Results: (Please check one) ACCEPTABLE (5 or few points) Off Campus Trip LENS Check Packet The LENS check packet is required when a student is driving their personal car or driving a rental car to a University approved activity. Return the completed packet to

More information

Polar Bear Girls Youth Hockey

Polar Bear Girls Youth Hockey Polar Bear Girls Youth Hockey 2015 Tournament Registration Form: Palouse Care Cup Girls Hockey Tournament Feb. 6 th 8 th, 2015 $600 Register: Please complete the information below and return with a team

More information

IOWA STATE UNIVERSITY SPRING JUDO CHAMPIONSHIP

IOWA STATE UNIVERSITY SPRING JUDO CHAMPIONSHIP IOWA STATE UNIVERSITY SPRING JUDO CHAMPIONSHIP DATE: Sunday, April 21, 2012 LOCATION: Forker Building, Iowa State University, Ames, Iowa SANCTION: Applied for WEIGH-INS: 8:00 10:00 AM COMPETITION: Juniors

More information

Orangebrook Golf & Country Club

Orangebrook Golf & Country Club Greetings! It s a new year at Orangebrook Golf & Country Club! We are looking forward to welcoming back our renewing members and greeting new friends for the 2014-2015 year. We have served our patrons

More information

Texas A&M University-Corpus Christi Youth Program Medical Emergency Information/Consent for Treatment

Texas A&M University-Corpus Christi Youth Program Medical Emergency Information/Consent for Treatment Texas A&M University-Corpus Christi Youth Program Medical Emergency Information/Consent for Treatment Youth s name: Address: Date of birth: Parent/guardian phone: Home Work Pager/Cellular Medical Information

More information

3004 S. Rancho Dr. Las Vegas, NV. 89102 * PH: 702-220-5614 * www.tevakanui.com

3004 S. Rancho Dr. Las Vegas, NV. 89102 * PH: 702-220-5614 * www.tevakanui.com 2009/2010 Policy Agreement I have received a copy of the 2009/2010 studio policy and current class schedule. I agree to adhere to all studio policies as contained in this document and explained to me.

More information

Registration Form Spots are limited and on a first come first serve basis

Registration Form Spots are limited and on a first come first serve basis UT Houston Medical School s JAMP Symposium March 27 th or April 17 th, 2015 Registration Form Spots are limited and on a first come first serve basis Please Note: Registration is not complete until you

More information

REGISTRATION & MEDICAL FORM

REGISTRATION & MEDICAL FORM REGISTRATION & MEDICAL FORM NAME ADDRESS CITY PROV POSTAL TELEPHONE E-MAIL CLUB BIRTH DATE DD/ MM / YYYY AGE (on Dec. 31, 2011) GENDER: M F MB MEDICAL # For Office Use Only: Plate number: Category: Amount

More information

Earn money from you racing, from your pictures, Youtube videos and more! Only by posting on DRR Riders Group on Facebook.

Earn money from you racing, from your pictures, Youtube videos and more! Only by posting on DRR Riders Group on Facebook. Earn money from you racing, from your pictures, Youtube videos and more! Only by posting on DRR Riders Group on Facebook. Eligibility: All payouts are based on model year Current model year vs non current

More information

Thank you for your interest in volunteering at Trinitas Regional Medical Center.

Thank you for your interest in volunteering at Trinitas Regional Medical Center. Thank you for your interest in volunteering at Trinitas Regional Medical Center. Please be advised that each participant in the Trinitas Regional Medical Center Volunteer program must complete the following

More information

Atlanta 04.05.14. Party. Check-In. Welcome to The Color Run! Check-in Party

Atlanta 04.05.14. Party. Check-In. Welcome to The Color Run! Check-in Party Atlanta 04.05.14 Welcome to The Color Run! We have developed this race guide to provide you with all the information you will need to make your experience at the event as FANTASTIC as possible. You and

More information

Race Guide. Orange County. Packet Pick-Up. Be Happy. Be Healthy. Be You. Welcome to The Color Run!

Race Guide. Orange County. Packet Pick-Up. Be Happy. Be Healthy. Be You. Welcome to The Color Run! Be Happy. Be Healthy. Be You. Race Guide Orange County Welcome to The Color Run! Thanks to you and all of your newest friends for making The Color Run one of America s biggest 5k events! We have made this

More information

California Polytechnic State University, Pomona Vietnamese Student Association. Family. Honor. Tradition.

California Polytechnic State University, Pomona Vietnamese Student Association. Family. Honor. Tradition. California Polytechnic State University, Pomona Vietnamese Student Association Family. Honor. Tradition. ACCIDENT WAIVER AND RELEASE OF LIABILITY FORM Name of Activity or Event: CAL POLY POMONA VSA WINTER

More information

5k Run/Walk hosted by the Rochester Hills Government Youth Council

5k Run/Walk hosted by the Rochester Hills Government Youth Council 5k Run/Walk hosted by the Rochester Hills Government Youth Council to benefit the Saturday, June 13, 2015 Bloomer Park Rochester Hills, Michigan 8:30 a.m. 10:30 a.m. Registration Brochure Blessings in

More information

2016 LakeRacer LLC Desert Storm Event Registration Forms. POKER RUN EVENT TERMS AND CONDITIONS

2016 LakeRacer LLC Desert Storm Event Registration Forms. POKER RUN EVENT TERMS AND CONDITIONS POKER RUN EVENT TERMS AND CONDITIONS The registration fees: Each entry includes Two poker hands, two t-shirts, two adult entries for the registration party, awards banquet, prize drawings, and an aerial

More information

APPLICATION TO PARTICIPATE AS A MEMBER OF A USA INLINE HOCKEY TEAMS Team Selection made by Resume Only

APPLICATION TO PARTICIPATE AS A MEMBER OF A USA INLINE HOCKEY TEAMS Team Selection made by Resume Only APPLICATION TO PARTICIPATE AS A MEMBER OF A USA INLINE HOCKEY TEAMS Team Selection made by Resume Only XIV FIRS Senior Women/Junior Men Inline Hockey World Championships Rosario, Argentina Arrival - Saturday,

More information

Race Guide. Seattle. Packet Pick-Up. Be Happy. Be Healthy. Be You. Welcome to The Color Run! Seattle Center Pavillion 305 Thomas St Seattle, WA 98109

Race Guide. Seattle. Packet Pick-Up. Be Happy. Be Healthy. Be You. Welcome to The Color Run! Seattle Center Pavillion 305 Thomas St Seattle, WA 98109 Be Happy. Be Healthy. Be You. Race Guide Seattle Welcome to The Color Run! Thanks to you and 7,500 of your newest friends for making The Color Run one of America s biggest 5k events! We have made this

More information

RYE AIRFIELD 6 AIRFIELD DRIVE RYE, NEW HAMPSHIRE 03870 WAIVER, RELEASE OF LIABILITY AND INDEMNITY AND HOLD HARMLESS AGREEMENT PARTICIPANT S NAME

RYE AIRFIELD 6 AIRFIELD DRIVE RYE, NEW HAMPSHIRE 03870 WAIVER, RELEASE OF LIABILITY AND INDEMNITY AND HOLD HARMLESS AGREEMENT PARTICIPANT S NAME RYE AIRFIELD 6 AIRFIELD DRIVE RYE, NEW HAMPSHIRE 03870 WAIVER, RELEASE OF LIABILITY AND INDEMNITY AND HOLD HARMLESS AGREEMENT PARTICIPANT S NAME UNDER 18 YEARS (SIGNED AND INITIALED BY PARTICIPANT AND

More information

Hornets Youth Enrichment Summer Program 1200 North DuPont Highway Dover, Delaware 19901 Telephone: 302-857-6824 Fax: 302-857-6823

Hornets Youth Enrichment Summer Program 1200 North DuPont Highway Dover, Delaware 19901 Telephone: 302-857-6824 Fax: 302-857-6823 Hornets Youth Enrichment Summer Program 1200 North DuPont Highway Dover, Delaware 19901 Telephone: 302-857-6824 Fax: 302-857-6823 Participant Last Name: Participant First Name: Grade: Age: Gender: Male

More information

Hope s Youth Ministry High School Retreat

Hope s Youth Ministry High School Retreat Hope s Youth Ministry High School Retreat March 6-8, 2015 Pocono Plateau Cresco, PA Hope s Youth Ministry PO BOX 914, 700 Cooper Rd. Voorhees, NJ 08043 Questions or for further information: dave@meethope.org

More information

Presents The 8th Annual Atlanta Ice Dance Weekend June 5-7, 2015 The Cooler, Alpharetta, Georgia

Presents The 8th Annual Atlanta Ice Dance Weekend June 5-7, 2015 The Cooler, Alpharetta, Georgia http://atlantaicedanceweekend.weebly.com/index.html Presents The 8th Annual Atlanta Ice Dance Weekend June 5-7, 2015 The Cooler, Alpharetta, Georgia The Atlanta Figure Skating Club is pleased to host the

More information

Personal/Athletic Training Agreement

Personal/Athletic Training Agreement Personal/Athletic Training Agreement Standard Fitness Training ½ Hour Session Total Package Cost Price Per Session Expiration Terms Packages 10 Sessions $300 $30.00 Sessions expire 10 weeks 20 Sessions

More information

Chang Scholarship Student Information

Chang Scholarship Student Information Chang Scholarship Student Information The mission of the Davis Schools Orchestral Music Association (DSOMA) is to support music students and the music program in general. Our music teachers believe that

More information

YOUTH MENTORING PROGRAM. Mentee Application (To Be Completed by the Parent/Guardian)

YOUTH MENTORING PROGRAM. Mentee Application (To Be Completed by the Parent/Guardian) Personal Information YOUTH MENTORING PROGRAM Mentee Application (To Be Completed by the Parent/Guardian) Youth s Name: Date: Parent/Guardian Name: Relationship to Youth: Mother Father Other, specify: Street

More information

Karate Adventure Summer Camp

Karate Adventure Summer Camp Karate Adventure Summer Camp Our Summer Karate Camp is one of the most unique summer camps available to children. It provides an enriching selection of self defense activities as well as many fun summer

More information

UNIVERSITY OF HOUSTON

UNIVERSITY OF HOUSTON JAMES DICKEY'S UNIVERSITY OF HOUSTON 2014 MEN'S BASKETBALL CAMPS CAMP FEATURES Expert instruction from Houston Basketball staff and student-athletes Outstanding lectures Grouping of all players by ages

More information

2016 USA SHOOTING SHOTGUN NATIONAL CHAMPIONSHIPS COLORADO SPRINGS, CO JULY 10-19, 2016

2016 USA SHOOTING SHOTGUN NATIONAL CHAMPIONSHIPS COLORADO SPRINGS, CO JULY 10-19, 2016 2016 USA SHOOTING SHOTGUN NATIONAL CHAMPIONSHIPS COLORADO SPRINGS, CO JULY 10-19, 2016 WHATS NEW Due to high demand, it is now required that everyone making entry into our 2016 USAS Shotgun National Championships

More information

Shotgun Coaching Workshop Registration and Information Package

Shotgun Coaching Workshop Registration and Information Package Shotgun Coaching Workshop Registration and Information Package Edmonton Conservation Education Centre for Excellence #88, 4003 98 th Street Edmonton, Alberta, Canada T6E 6M8 Phone: (780) 466-6682 or Toll

More information

San Jose 05.31.14. Party. Check-In. Welcome to The Color Run! Check-in Party. Where: Sports Authority 5170 Steven Creek Blvd, San Jose, CA 95129

San Jose 05.31.14. Party. Check-In. Welcome to The Color Run! Check-in Party. Where: Sports Authority 5170 Steven Creek Blvd, San Jose, CA 95129 San Jose 05.31.14 Welcome to The Color Run! We have developed this race guide to provide you with all the information you will need to make your experience at the event as FANTASTIC as possible. You and

More information

Registration Instructions 2016. Thanks for joining the Waves Swim Team!

Registration Instructions 2016. Thanks for joining the Waves Swim Team! Registration Instructions 2016 Hello, Thanks for joining the Waves Swim Team! Walk Up Registration and Swim Suit fitting March 6 th, 2:00 5:00pm at the Richland Clubhouse. Please fill out: 1. Registration

More information

2016 Michigan State Games Judo Sanction: USJF# 16-06-05 http://stategamesofmichigan.com/judo http://konanjudo.wordpress.com/

2016 Michigan State Games Judo Sanction: USJF# 16-06-05 http://stategamesofmichigan.com/judo http://konanjudo.wordpress.com/ DATE: Saturday, June 25, 2016 LOCATION: Kroc Center 2500 S. Division Street. NE Grand Rapids, MI 49507 ELIGIBILITY: All contestants must provide a valid U.S.J.F., U.S.J.I., or U.S.J.A. card. Foreign contestants

More information

2015 ADF School Medical/Insurance Information & Liability Waivers INSURANCE INFORMATION

2015 ADF School Medical/Insurance Information & Liability Waivers INSURANCE INFORMATION These forms must be completed and signed in all appropriate places by the participant, the participant s physician, and if under age 18, by the participant s legal guardian. The medical information we

More information

PROJECT EXCEL MENTORING PROGRAM Creating Vision Through Mentoring / What They See is What They Will Be

PROJECT EXCEL MENTORING PROGRAM Creating Vision Through Mentoring / What They See is What They Will Be Personal Information Mentee Application (To Be Completed by the Parent/Guardian) Youth s Name: Date: Parent/Guardian Name: Relationship to Youth: Mother Father other, specify: Street Address: City: State:

More information

Motorcycle RiderCourse WAIVERS

Motorcycle RiderCourse WAIVERS Motorcycle RiderCourse WAIVERS General Instructions All pages must be completed and signed. If you have any questions, call (231) 591-5819. Mail completed forms to: Motorcycle Rider Courses, Ferris State

More information

2014 TOTAL WIMPS ODE

2014 TOTAL WIMPS ODE TARC PROUDLY PRESENT THE 2014 TOTAL WIMPS ODE Equestrian Park Curtin Sunday 26 th October, 2014 TARC is pleased to present our annual One Day Event for the less confident rider (aka The Wimps). There will

More information

Location: Burlington County College, 601 Pemberton-Browns Mills Rd, Pemberton, NJ PE Building, Parking Lot 12

Location: Burlington County College, 601 Pemberton-Browns Mills Rd, Pemberton, NJ PE Building, Parking Lot 12 United States Masters Swimming Delaware Valley Masters 2013 Burlington County College Masters Swim Meet Date and Time: Sunday March 30, 2014 Warm Up: 8:00 AM Start Time: 9:00 AM Location: Burlington County

More information

2016 FLORISSANT SUMMER PLAYGROUND INFORMATION AND POLICIES

2016 FLORISSANT SUMMER PLAYGROUND INFORMATION AND POLICIES 2016 FLORISSANT SUMMER PLAYGROUND INFORMATION AND POLICIES CAMP LOCATIONS CAMP DATES/TIMES June 6 July 15, 2016 James J. Eagan Center (300) 9:00am 3:00pm Koch Park (320) No camp July 4th All Prices Subject

More information

Registration Form - Summer Masters Membership

Registration Form - Summer Masters Membership Registration Form - Summer Masters Membership Please provide all requested information and SIGN the Waiver and Medical Information forms located on the website Last Name: First Name: Address: City: Postal

More information

LIMESTONE DISTRICT GRENADIERS FOOTBALL CLUB

LIMESTONE DISTRICT GRENADIERS FOOTBALL CLUB LIMESTONE DISTRICT GRENADIERS FOOTBALL CLUB 2016 PLAYER REGISTRATION PACKAGE Welcome to the Grenadiers Football Family! Enclosed in this handbook is the information that will help you prepare for your

More information

2016 Teen Volunteer Application Form

2016 Teen Volunteer Application Form Monona Public Library Summer Library & Reading 2016 Teen Volunteer Application Form The Teen Volunteer program is for youth entering grade 6 to entering grade 12. It is an opportunity for teens to interact

More information

City of Kennedale c/o Art in the Park 405 Municipal Drive Kennedale, TX 76060

City of Kennedale c/o Art in the Park 405 Municipal Drive Kennedale, TX 76060 Dear Art Festival Applicant: The Art in the Park Committee and the City of Kennedale invite you to apply to participate in the Fifth Annual Art in the Park Arts Festival to be held April 4 6, 2014. Please

More information

SOUTH DAKOTA 4-H RODEO CONTESTANT PACKET

SOUTH DAKOTA 4-H RODEO CONTESTANT PACKET igrow.org SOUTH DAKOTA 4-H RODEO CONTESTANT PACKET August 19 21, 2016 In This Packet: Official Rodeo Entry Form Parent or Guardians Agreement of Waiver of Liability Indemnification and Medical Release

More information

INTERNATIONAL LEADERSHIP OF TEXAS

INTERNATIONAL LEADERSHIP OF TEXAS INTERNATIONAL LEADERSHIP OF TEXAS ACKNOWLEDGMENT OF RISK, INDEMNITY, WAIVER AND RELEASE OF LIABILITY AGREEMENT, NOTICE OF FINANCIAL RESPONSIBILITY, AND MEDICAL AUTHORIZATION & INFORMATION FORM IN WITNESS

More information

Saturday, August 23 rd, 2014 10 am Long Beach Airport 2019 E. Wardlow rd. (Off of Globemaster Way) Long Beach, CA 90807

Saturday, August 23 rd, 2014 10 am Long Beach Airport 2019 E. Wardlow rd. (Off of Globemaster Way) Long Beach, CA 90807 2014 LETR 9 th Annual Plane Pull for Special Olympics Southern California Team Captain Packet Saturday, August 23 rd, 2014 10 am Long Beach Airport 2019 E. Wardlow rd. (Off of Globemaster Way) Long Beach,

More information

WELCOME TO YMCA Teen Scene Middle School Enrichment Program (This sheet is for parents to keep for informational purposes)

WELCOME TO YMCA Teen Scene Middle School Enrichment Program (This sheet is for parents to keep for informational purposes) Robert D. Fowler Family YMCA Middle School Enrichment Program Student Registration Form 2015-16 Ivy Prep Academy Program Hours: 7am-7:45am & 4pm-7pm Transportation AM: Group leaves at 7:30am Transportation

More information

Child and Youth Group. Volunteer Waiver Form

Child and Youth Group. Volunteer Waiver Form Child and Youth Group Volunteer Waiver Form VOLUNTEER WAIVER WARNING OF RISK, WAIVER, RELEASE OF ALL CLAIMS AGREEMENT Please read this form carefully and be aware that, in participating, you will be waiving

More information

TSF Player Invitation Inter Academy Program U9-U12 Boys & Girls

TSF Player Invitation Inter Academy Program U9-U12 Boys & Girls TSF Player Invitation Inter Academy Program U9-U12 Boys & Girls TSF Academy would like to extend an invitation to play soccer with our Inter Academy Program. We are very excited about the upcoming season.

More information

North Dakota College Tour

North Dakota College Tour North Dakota College Tour University of North Dakota North Dakota State University Minnesota State University, Moorhead Friday, October 31 - Saturday, November 1, 2014 Open to Sophomores, Juniors, and

More information

INVITATION. To All Member Associations 24.11.2010

INVITATION. To All Member Associations 24.11.2010 INVITATION To All Member Associations 24.11.2010 Dear Member Associates, On behalf of the Organizing Committee of the Turkish Archery Federation (TAF) we kindly would like to invite you to take part in

More information

INDEMNITY AND HOLD HARMLESS AGREEMENT

INDEMNITY AND HOLD HARMLESS AGREEMENT MIAMI-DADE COUNTY, FLORIDA MEDICAL EXAMINER DEPARTMENT NUMBER ONE ON BOB HOPE ROAD MIAMI, FLORIDA 33136-1133 (305) 545-2400 INDEMNITY AND HOLD HARMLESS AGREEMENT A. (Insert the name) (the Agency) agree(s)

More information

2015 ONTARIO PROVINCIAL TAEKWON-DO CHAMPIONSHIPS

2015 ONTARIO PROVINCIAL TAEKWON-DO CHAMPIONSHIPS 2015 ONTARIO PROVINCIAL TAEKWON-DO CHAMPIONSHIPS SATURDAY OCTOBER 17 2015 HABER COMMUNITY CENTRE 3040 TIM DOBBIE DRIVE, BURLINGTON, ONTARIO COLOUR BELT COMPETITIONS START AT 9:00 AM HOSTED BY RAI S TAEKWON-DO

More information

Name of Coach: Qualifications: (Attach resume) Please list qualifications and experiences relating to coaching this activity:

Name of Coach: Qualifications: (Attach resume) Please list qualifications and experiences relating to coaching this activity: University of California, Irvine Campus Recreation CLUB SPORTS VOLUNTEER COACH AGREEMENT PLEASE PRINT LEGIBLY Name of Sport Club: Year: Name of Coach: Home Address: Daytime Phone #: Cell Phone #: E-mail

More information

Culinary Arts Academy Admission Application

Culinary Arts Academy Admission Application Culinary Arts Academy Admission Application Institute for Hospitality & Tourism Education and Research 3000 N.E. 151st Street, KCC 3RD FL North Miami, FL 33181-3000 Please download, complete and save the

More information

SOUTH DAKOTA 4-H RODEO CONTESTANT PACKET

SOUTH DAKOTA 4-H RODEO CONTESTANT PACKET igrow.org SOUTH DAKOTA 4-H RODEO CONTESTANT PACKET August 14 16, 2015 In This Packet: South Dakota 4-H Rodeo Entry Instructions Official Rodeo Entry Form Parent or Guardians Agreement of Waiver of Liability

More information

Amnesty International - Requirements For 2015 Regional Conferences

Amnesty International - Requirements For 2015 Regional Conferences Amnesty International USA sponsors special enrichment events for youth leaders as a means of providing a comprehensive and diverse learning environment to further their understanding of and participation

More information

One Day Show Bill ~ Thursday, July 9th, 2014, 8:00 a.m. Location: Red River Valley Fairgrounds Check-in Opens at 7:00 a.m.

One Day Show Bill ~ Thursday, July 9th, 2014, 8:00 a.m. Location: Red River Valley Fairgrounds Check-in Opens at 7:00 a.m. One Day Show Bill ~ Thursday, July 9th, 2014, 8:00 a.m. Location: Red River Valley Fairgrounds Check-in Opens at 7:00 a.m. Judge: Laurie Holverson Dressage test Pre-entries must be postmarked on or before

More information

Summer Skating School. Hoover Arena operated by Ice Land USA 15381 Royalton Road Strongsville, Ohio 44136 440-268-2800 www.icelandusa.

Summer Skating School. Hoover Arena operated by Ice Land USA 15381 Royalton Road Strongsville, Ohio 44136 440-268-2800 www.icelandusa. Ice Cream Socials Free sundae with paid admission June 6 th June 13 th June 27 th July 11 th July 18 th July 25 th August 8 th August 15 th August 22 nd Sundays 6:30 8:30 pm Learn to Skate Lessons Summer

More information

2015 Mid-Atlantic Challenged Sports Championships REGISTRATION

2015 Mid-Atlantic Challenged Sports Championships REGISTRATION 2015 Mid-Atlantic Challenged Sports Championships REGISTRATION Athlete Name Last: First: Birth Date: Classification: Track Field Swimming Athletes must be classified before events. WV Challenged Sports

More information

WESTERN NEW YORK OFFSHORE POWERBOAT ASSOC., INC. 2015 BUFFALO POKER RUN - AUGUST 7-8, 2015

WESTERN NEW YORK OFFSHORE POWERBOAT ASSOC., INC. 2015 BUFFALO POKER RUN - AUGUST 7-8, 2015 WESTERN NEW YORK OFFSHORE POWERBOAT ASSOC., INC. 2015 BUFFALO POKER RUN - AUGUST 7-8, 2015 ASSUMPTION AND ACKNOWLEDGMENT OF RISK AND RELEASE OF LIABILITY WAIVER 1. ALL OF THE UNDERSIGNED, DO HEREBY AFFIRMATIVELY

More information

Race Guide. South Portland. Check-In Party. Be Happy. Be Healthy. Be You. Welcome to The Color Run!

Race Guide. South Portland. Check-In Party. Be Happy. Be Healthy. Be You. Welcome to The Color Run! Be Happy. Be Healthy. Be You. Race Guide South Portland Welcome to The Color Run! Thanks to you and 5,000 of your newest friends for making The Color Run one of America s biggest 5k events! We have made

More information

Rules & Regulations Treasure Mountain Festival s Queen/Teen/Preteen/Ms. Pageant

Rules & Regulations Treasure Mountain Festival s Queen/Teen/Preteen/Ms. Pageant Rules & Regulations Treasure Mountain Festival s Queen/Teen/Preteen/Ms. Pageant 1. Queen Contestants must be 16 by September 1, 2016 and not have reached her 22 nd birthday on or before January 1, 2017,

More information

Initial. Registration Packet. Summer Academy June 3 rd to August 30 th Z M G. www.zmgtennis.com. HP and TTT Registration Form 1 ZMG Tennis, LLC

Initial. Registration Packet. Summer Academy June 3 rd to August 30 th Z M G. www.zmgtennis.com. HP and TTT Registration Form 1 ZMG Tennis, LLC Registration Packet Summer Academy June 3 rd to August 30 th Z M G www.zmgtennis.com HP and TTT Registration Form 1, LLC Enrolment Process prides its self on offering everything essential in the development

More information

2015 Coach E s Flagler College Basketball Camps

2015 Coach E s Flagler College Basketball Camps 2015 Coach E s Flagler College Basketball Camps Necci Brown 2015 Averaged a 31.9 field goal percentage during her career as a Saint July 13-17 Camp Registration Campers cannot be admitted without full

More information

LATE PAYMENT FEES WITHDRAWAL FROM THE PROGRAM THIRD PARTY (SPLIT) PAYMENTS RESPONSIBLE PARTY. Parent/Guardian Agreement: Dear Parents and Guardians,

LATE PAYMENT FEES WITHDRAWAL FROM THE PROGRAM THIRD PARTY (SPLIT) PAYMENTS RESPONSIBLE PARTY. Parent/Guardian Agreement: Dear Parents and Guardians, Dear Parents and Guardians, In order to simplify and provide better service to everyone, Rancho Simi Recreation and Park District ( the District ) has implemented the following payment processing procedures

More information

TxSWANA. Houston, Texas. June 26 th and 27 th. Registration Packet. Sponsored by the City of Houston and Republic Services

TxSWANA. Houston, Texas. June 26 th and 27 th. Registration Packet. Sponsored by the City of Houston and Republic Services 2015 TxSWANA ROAD-E-O Houston, Texas June 26 th and 27 th Registration Packet Sponsored by the City of Houston and Republic Services 2015 TxSWANA Lone Star Chapter Road-E-O WAIVER OF LIABALITY AND RELEASE

More information

Aquaculture, Biology, and Conservation Summer Camp 2015 Registration Forms

Aquaculture, Biology, and Conservation Summer Camp 2015 Registration Forms Aquaculture, Biology, and Conservation Summer Camp 2015 Registration Forms All forms and payment are due no later than June 15, 2015 Note: There is a $25 non-refundable registration fee, and no refunds

More information

2010 USJA/USJF WINTER NATIONALS SENIORS MASTERS JUNIORS KATA

2010 USJA/USJF WINTER NATIONALS SENIORS MASTERS JUNIORS KATA 5 th ANNIVERSARY 2010 USJA/USJF WINTER NATIONALS SENIORS MASTERS JUNIORS KATA SATURDAY & SUNDAY DECEMBER 4 & 5, LA VERNE, CA Hosted by GOLTZ JUDO TOURNAMENT DIRECTOR: Gary Goltz HEAD REFEREE: Hayward Nishioka

More information

Please list below any medical conditions and/or allergies the DBA Faculty should be

Please list below any medical conditions and/or allergies the DBA Faculty should be 2015-2016 Registration Form Name Of Child(ren): Date of Birth: Address Where Child Resides: Mailing Address (if different from above): Home Phone Number: Please check next to whom the child resides with:

More information

Vancouver Pescaderos Dive Club Application for Membership

Vancouver Pescaderos Dive Club Application for Membership Vancouver Pescaderos Dive Club Application for Membership Note: If applying as a family, each person is to fill an application. First application is "primary", subsequent applications in the same family

More information