Hershey Track and Field Saturday May 5 , 2012 at Century Field ...

Hershey Track and Field
Saturday May 5 th , 2012 at Century Field, Yorkton starting 12 noon.
Fax both pages to Bob Edwards at 306 593 2220 by May 01
Any questions e-mail bvedwards@sasktel.net
Entry Form
Last Name ______________________________
First Name ____________________
Parent or Guardian ___________________________________
Address ________________________________
City/Town ____________________
Postal Code _____________ Name of school or community
_______________________
e-mail:
Date of Birth
Year__________ Month ___________ Day ____________
Age as of December 31, 2012 _________________
Please bring proof of birthdate with you to the meet
Age Group - please check 9&10 yrs old girls (born 2002 or 2003)
9&10 yrs old boys (born 2002 or 2003)
11&12 yrs old girls (born 2000 or 2001)
11&12 yrs old boys (born 2000 or 2001)
13&14 yrs old girls (born 1998 or 1999)
13&14 yrs old boys (born 1998 or 1999)
You may enter Three Track events and One Field event OR
Two Track event and Two Field events
The relay counts as one track event
Events entered - please check
Standing Long Jump
Softball Throw
50m Dash (9&10 only)
100m Dash
200m Dash
400m Dash (9&10, 11&12 only)
800m Run (11&12, 13&14 only)
1600m Run (13&14 only)
4 x 100m Relay
Cont . . .
Hershey Entry cont.

Relevant Medical Conditions: ___________________________________________
____________________________________________
Emergency Contact: ___________________________________________________
THE APPROPRIATE SIGNATURE SECTION MUST BE COMPLETED FOR
EACH PARTICIPANT
The above named participant and 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 sponsoring agency's facilities and
equipment, both the participant and the parents/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 or her own
behalf and on the behalf of his or her heir, executors, administrators and assigners
hereby release, discharge and agree to hold harmless Hershey Foods Corporation and
its franchises and the National Recreation and Park Association, the National
Association for Sports & Physical Education and the President's Council on Physical
Fitness and Sports and Athletics Canada.
We understand that those participants who advance to the provincial level and are
winners at this level do not automatically advance to the regional level for the North
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 participant form is correct.
Parent or Guardian's Signature ____________________________________________
Athlete’s Signature ____________________________________________________
First and Second place finishers in all events will be invited to compete in the Provincial
Meet at Griffiths Stadium, Saskatoon on June 16 - entry forms will be handed out in
Yorkton.
The Hershey meet is designed so that anyone is able to participate, so there is no entry fee
for Yorkton or Saskatoon, and track or ball spikes or starting blocks are not allowed (but
athletes must wear shoes). All participants receive participation ribbons and ribbons are
awarded for first, second and third places.