Mail In Registration
Inaugural Nature Coast Middle School Track and Field Championship and Elementary Track and Field Classic
April 20, 2013
Lecanto High School Track and Field Complex
Pre Event Pickup: April 19, 4:30-6:30
Dates/TIMES: April 20, 9 a.m. until finished
Location: Lecanto High School Sports Complex
Cost: $25 for team in middle school division/ $10 for individual in middle school division/$8.00 for elementary division
Amenities: Middle school division= team championship award, 1st-6th recognition;
Elementary division= participation ribbon for all, bibs, etc.
Profits obtained from the registration charges will be used for Girls’ Cross Country at Lecanto High School. The event organizers will be compensated.
NO EXPERIENCE NECESSARY! Bibs will be used for all events.
There is event day registration. There will be a concession stand available.
Contact Dan Epstein at CRMS( ) or email at epsteind@citrus.k12.fl.us OR Colleen Epstein at Rock Crusher Elementary (795 2010) or email at epsteinc@citrus.k12.fl.us for a registration form if needed and more information on this or any other items.
REGISTRATION OPTIONS: 1. Online at active.com for individuals; there is a service fee through active.com. On active.com, you may use a credit card Go to active.com and type in Lecanto and search; it will come up there. 2. You can register by returning the form below. 3. You can drop off registration at the following locations: LHS (ATT:Dan Epstein-Cross Country) or RCES(ATT: Colleen Epstein) NO REFUNDS.
Please Cut Off and Return to: The Legends Meet C/O Dan Epstein, Lecanto High School, 3810 West Educational Path, Lecanto, Florida 34461 Make Checks Payable to: LECANTO HIGH SCHOOL
Team Entry
TEAM Name: ___________________________________ Coach:___________________________
Coach Contact email/phone number : _____________________________________- ________________
(if a team, go to waiver below and sign and you are done- will need rosters by April 19, noon; contact Dan or Colleen Epstein at above email addresses to receive template for rosters)
Individual Entry
Name: ______________________________________________ Grade: _____ M/F____
I do ____ do not ___give permission for my photo/child if under 18 to be placed on the event website.
Web site address = https://sites.google.com/site/athleticsscoringproviders/2013-track-and-field-meets/the-inaugural-nature-coast-middle-school-track-and-field-invitational-and-elementary-school-classic (check for updates )
Event-check event entering: ________ Individual Middle School ________ Elementary
Address: (include zip) ___________________________________ Email Address: ________________
Parent/Guardian)___________________________Phone: H ______________ W____________
Emergency Contact: ____________________________________ Phone: ________________________
Insurance Company: _________________________________ Policy #: _________________________
Allergies or medical conditions:_________________________________________________________
WAIVER
I understand that running/walking is a physical sport and injuries may occur. I release the coaches, team members, sponsors, staff and administration of Lecanto High School, the Citrus County School Board, the employees or sub-contractors from David D Bullock, LLC from any legal responsibilities for any possible injury or consequences that may occur. I also authorize the meet director/club sponsor of the event to act on my behalf if an injury occur and I cannot answer responsibly. I understand if my child under the age of 18 is participating, the same procedures apply to my child.
(Parent)Signature: ________________________________________________ Date: __________________________________
Date received: _____________________ Payment Type: Check #_____________________ Cash: ____________________ Received by: _________