Philadelphia Track Pentathlon & Throws Triathlon Sunday 8/15/2010 Entry Form
(Print all information clearly)
Name____________________________________ Phone__________________________
E- Mail____________________________________________________________________
Address___________________________________________________________________
City_______________________________ State_________ Zip_____________________
Sex ___________(M/F) Age on Event Day_______________(8/15/10)
Event you are Competing In (Choose One)
_____ Track Pentathlon (3000, 800,200,1500, 400) Best recent 800 meter time:_________
_____ Throws Triathlon (Shot Put, Javelin, Discus) Best recent distances for :
Shot Put____________ Javelin______________ Discus_______________
T- shirt size (S- M- L- XL- XXL) _________
Checks payable to : Philadelphia Athletic Charities
Mail to : Philadelphia Athletic Charities
611 Jamestown Street
Philadelphia Pa 19128
Waiver: In consideration of your accepting my entry in this meet, I waive my right to sue Philadelphia Athletic Charities, Gwynedd
Mercy Academy HS, Ambler Olympic Club, USATF, Greater Philadelphia Track Club, and any and all organizations, sponsors, volunteers
and individuals associated with this meet for any injuries, damages, and losses I may sustain in connection with said meet. The
waiver binds my heirs, administrators, and assigns as well as me. I assure that I have trained for the meet and have been cleared by
a licensed physician to compete in this meet. I issue permission to the meet producers to use my image from the event for any future
media or promotional purposes associated with the Philadelphia Track Pentathlon & Throws Triathlon.
____________________________________________________ ____________________
(Signature by participant or by parent of legal guardian if under 18) Date
