Denville Striders Track and Field
Registration Form
All applicants must reside in Denville
Application Deadline is Friday, March 6, 2009*
*No application will
be accepted after this date
Child’s Name:
_________________________________________________________________
Street: ________________________________________________________________________
City: __________________________ State: _______ ZIP: ________________________
Telephone: _____________________ Sex: M
F Email: _______________________
Birthday (MM/DD/YY):_____________ Age as of (12/31/09):________________________
School: _________________________ Current Grade: _____________________________
SHIRTS – Please Indicate Size
Youth Small Youth Medium Youth Large Youth X-Large Adult Small Adult Medium Adult Large Adult Ex-Large
Parental Consent
I hereby grant permission
for my child to participate in all activities of the Denville Track and Field
Program. I assume all other risks and hazards incidental to the conduct of the
program activities and transportations to and from program activities. I do further
release, absolve, indemnify, and hold harmless organizers, sponsors, field owners,
its members, coaches or any of the supervisors appointed by them. I likewise
release from my responsibility any person transporting my child to or from
program activities.
Parent/ Legal Guardian:
__________________________Spouse’s Name: ____________________
Print Name Above: _________________________________ Date: ____________________
FEE $25 dollars per child
Other children in program:
___________________________________________________________
Please mail registration form
and check to: Mary
Farrelly