2013 Hershey's Track and Field Youth Program (March 9, 2013)

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THE HERSHEY YOUTH PROGRAM IS DESIGNED FOR THE BEGINNER ATHLETE Meet Date: March 9, 2013 (Saturday) Time: 10:00 am to 3:00 pm (Approximate) Place: Keaau High School Track Oval REGULATIONS ELIGIBILITY: Open to 9-14 year old girls and boys born between 1999-2004, who reside in Hawaii. Six divisions based on gender and age as December 31, 2013. must of All participants compete in their gender and age group division. ENTRY DEADLINE:Thursday, February 28, 2013 – 4:00 P.M. Department of Parks and Recreation Mail or Fax to: 799 Piilani Street Hilo, Hawaii ATTENTION: Darrell Yamamoto PHONE: 961-8740 FAX: 961-8736 EQUIPMENT: Shorts, t-shirts, and shoes are required. Track shoes (with or without spikes) are not permitted. Starting blocks are not allowed. PROOF OF AGE:A legal birth document must be presented for viewing upon registration on meet day. Age is determined by the age the youth will be on December 31, 2013. Shirt Size: Please Circle One GIRL BOY Please check the appropriate box:  GENDER: Youth – Med Large PLEASE TYPE OR PRINT IN BLACK INK Adult – Small Med Large NAME____________________________________________________________________________ LAST FIRST MI ADDRESS_______________________________________________________________ PHONE NO._____________________________ STREET CITY/ZIP DATE OF BIRTH: MONTH________ DAY________ YEAR (circle one) 1999 /2000 / 2001 / 2002 / 2003 / 2004 PROGRAM: _______________________________________ COACH’S NAME____________________ PHONE #_________________ (Name of Summer Fun Program,, track team, school. If none, write Unattached) Circle participant’s gender. Select up to three (3) events—not more than 2 running events. GENDER BIRTH YEAR Select no more than 2 running events (the relay is a running event) St. Long Jump* Softball Throw* G: 4’, B:4’6” G: 50’, B: 65’ GIRL 2003/2004 50M DASH 100M DASH 200M DASH 400M DASH 4X100 RELAY BOY GENDER BIRTH YEAR Select no more than 2 running events (the relay is a running event) St. Long Jump* Softball Throw* G: 4’6”, B: 5’ G: 75’, B: 90’ GIRL 2001/2002 100M DASH 200M DASH 400M DASH 800M RUN 4X100 RELAY BOY GENDER BIRTH YEAR Select no more than 2 running events (the relay is a running event) St. Long Jump* Softball Throw* G: 5’, B:6’ G: 100’,B: 110’ GIRL 1999/2000 100M DASH 200M DASH 800M RUN 1600M RUN 4X100 RELAY BOY * Note: Qualifying distances must be met to compete in the STANDING LONG JUMP AND SOFTBALL THROW EVENTS! 4x100M RELAY – Limited to 2 teams per division per organization. If you are a member of a relay team, you must list the other members of your relay team TEAM NAME: 1 2 3 4 ALT 1 ALT 2 ALT 3 The above named participant, the participant’s parent/guardian have requested registration of the participant in the Hershey Youth Program. In consideration of such registration, the right of the participant to compete in the Hershey Youth Program and the use by the participant of the sponsoring agency’s facilities, and equipment, both the participant and the parent/guardian each acknowledge that the participant will be competing in the Hershey Youth Program and sponsoring agency’s facilities at the participant’s sole risk and the participant on his/her own behalf and on behalf of his or her heir, executors, administrators and assigns, and parent/guardian shall indemnify, save and hold harmless The Hershey Company and its franchises and the National Recreation and Parks Association, USA Track & Field, Athletics Canada, Hawaii Recreation and Park Society, Keaau High School (DOE) and the Department of We understand that those participants who advance to the state/provincial level and are winners at this level do not automatically advance to the regional level for the North Parks and Recreation of Hawaii County. American Final Meet. This is covered under Rule 9, Article 1 in the rule book. We also agree to allow the Hershey Youth Program to use and reproduce the participant’s name and/or likeness and /or information concerning the participant and to circulate the same for any and all purposes in any manner. We certify that the information on this participation form is correct ______________________________________________ Print Name__________________________________ Date______________________________________ Signature of Parent or Legal Guardian In case of Emergency, Contact__________________________ _____________________________ Relationship_________________________________________  Or _______________________________________________ _____________________________ Relationship_________________________________________  I have checked this application and confirm its accuracy (coach/parent/guardian’s signature) __________________________________________________________ ENTRY DEADLINE: February 28, 2013 - 4:00 P.M. Go to www.hersheystrackandfield.com for more information