C:\USATF\USATF_PageMaker_Files\ 2006 RELAY ROSTER CHANGE FORM
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Only those athletes originally listed on the Relay Roster Form prior to the Jr. Olympic Association Championship are
eligible to be ENTERED on the Relay Roster Change Form. Note: Additions to the team Relay Roster Form may NOT
be made after the final entry-deadline: Thursday, June 16, 5:00 pm. (paper entries); Sunday, June 18, 9:00 pm (elec-
tronic entries).
Time Limits: The Relay Roster Change Form must be submitted to the Jr. Olympics Meet Registrar at least one hour prior
to the Report Call or scheduled check-in time for the event at each of the three meets in the Jr. Olympics
series.
Cost: $5.00 per athlete named on and ENTERED via the Relay Roster Change Form, payable when submitted to the Meet
Registrar.
Coach
, the 4-6 relay team members checked on the team Relay Roster Form are already ENTERED. You need only to
list or now ENTER any alternates you have previously listed on the team Relay Roster Form.
Please Print
RELAY ROSTER CHANGE FORM
Please Print
USATF Club______________________________________Age Division_______________________
£
Male
£
Female
Coach________________________________________________ REGION: VII, ASSOCIATION: Illinois
Check one:
£
4x100
£
4x400
£
4x800
ROSTER ALTERNATES _______________________________
______________________________ _________________________________ _______________________________
THE PURPOSE OF THIS RELAY ROSTER CHANGE FORM IS TO ENABLE CLUB COACHES TO
ENTER OR MAKE ELIGIBLE TO COMPETE THOSE ATHLETES WHO ARE LISTED AS ALTERNATES
(I.E., NOT TOP 6) ON THE RELAY ROSTER FORM.
2006 RELAY ROSTER CHANGE FORM
.
Only those athletes originally listed on the Relay Roster Form prior to the Jr. Olympic Association Championship are
eligible to be ENTERED on the Relay Roster Change Form. Note: Additions to the team Relay Roster Form may NOT
be made after the final entry-deadline: Thursday, June 16, 5:00 pm. (paper entries); Sunday, June 18, 9:00 pm (elec-
tronic entries).
Time Limits: The Relay Roster Change Form must be submitted to the Jr. Olympics Meet Registrar at least one hour prior
to the Report Call or scheduled check-in time for the event at each of the three meets in the Jr. Olympics
series.
Cost: $5.00 per athlete named on and ENTERED via the Relay Roster Change Form, payable when submitted to the Meet
Registrar.
Coach
, the 4-6 relay team members checked on the team Relay Roster Form are already ENTERED. You need only to
list or now ENTER any alternates you have previously listed on the team Relay Roster Form.
Please Print
RELAY ROSTER CHANGE FORM
Please Print
USATF Club______________________________________Age Division_______________________
£
Male
£
Female
Coach________________________________________________ REGION: VII, ASSOCIATION: Illinois
Check one:
£
4x100
£
4x400
£
4x800
ROSTER ALTERNATES _______________________________
______________________________ _________________________________ _______________________________
THE PURPOSE OF THIS RELAY ROSTER CHANGE FORM IS TO ENABLE CLUB COACHES TO
ENTER OR MAKE ELIGIBLE TO COMPETE THOSE ATHLETES WHO ARE LISTED AS ALTERNATES
(I.E., NOT TOP 6) ON THE RELAY ROSTER FORM. TO:
Parents of _________________________________
FROM: Club Coach, _________________________________
Dear Parent,
Please read, sign and return to me this USATF Waiver Form before the first practice session.
I know that competing and volunteering to work in club events and USATF-sanctioned competitions
are potentially hazardous activities. I know I should not allow my child to enter or participate in club
events or volunteer to assist with club activities unless I/they are medically able and properly prepared. I
agree to abide by any decision of a club or race official relative to this ability to safely complete any event
or to assist in any club activity. I assume all risks being associated with competing or volunteering to work
in club events and activities including; but not limited to falls, collisions, physical contact with other
competitors or spectators, the effects of the weather, including high heat or humidity, and, where appro-
priate, conditions of the road and traffic on the course -- all such risks being known and appreciated by me
and/or by any minors for whom I am authorized to act who, also or instead, do compete or volunteer to
assist as described above.
Having read this waiver and knowing these facts, and in consideration of your acceptance of my/my
childs application for membership, I, for myself, my heirs, and anyone acting on my behalf, waive and
release USATF Illinois, ________________________________________________
Print Club Name
and all officials, volunteers and all sponsors, their representative and successors from all claims or liabili-
ties of any kind arising out of participation in these club competitions or activities, even though that
liability may arise out of the negligence and carelessness on the part of the persons or organizations named
in this waiver. I also grant permission to all of the foregoing to use any photographs, motion pictures, video
or sound recordings, or any other record of the events or activities of the _______________________________ ,
including those involving me, for any legitimate purpose.
Print Club Name
Further, I grant permission for emergency medical treatment for myself and/or any minors for who I am
authorized to act by competent medical personnel. Allergies and current medications, if any, are as
follows:
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
Finally, I grant permission for my childs club coach or other named club official to represent and to
sign for me any club-athlete membership forms, entry forms and any and all other representations
required by USATF Illinois in order for my child to compete in USATF programs and events.
Athletes Name ___________________________________________
Print Athletes Name
Signature (Parent or guardian if athlete is under age 18) _______________________________________________
Emergency Phone ________/_________________________ Date ______________________________________
COACH: Once this WAIVER FORM has been signed by the athletes parent of guardian, you can
sign for the parent on the athletes membership form, meet entry form, and emergency medical
form, etc. On the latter forms, where required, write the name of the parent/guardian and, in
parentheses after, sign your name. Example: David R. Smith ( Bill Davis )
Club Coach: Retain this form in your files. Do not return to USATF Illinois Road Racing Cross Country Track & Field Race Walking
1213 Maple Ave, Lisle, IL 60532 630/512-0727 FAX 630/512-0728
USATF ILLINOIS
USATF ILLINOIS CLUB ATHLETE WAIVER FORM FOR: Athlete Membership Forms Meet Entry Forms Emergency Medical Forms, etc.
I L L I N O I S