2ND ANNUAL Y PUSH/PULL COMPETITION
ARE YOU STRONG
ENOUGH?
Best Bench Press and Best Deadlift
ALTAVISTA AREA YMCA ATHLETIC CENTER

Top 3 lifters under 200 lbs. using the Wilks formula

Top 3 lifters over 200 lbs. using the Wilks formula

Wrist wraps and weight belt only

Open to both men and women

All competitors will receive a T-shirt and will be entered into a drawing for a cash prize. Forms
can be picked-up at the Athletic Center or downloaded from our web site
WHEN:
May 21, 2016
Weigh Ins: May 20 8:00am-7:00pm & May 21
9:00am-noon
Cost: $10 each event/$20 for both
TIME:
1:00pm—5:00pm
DETAILS:
MANDATORY LIFTERS MEETING:
Prior to event start to review what is a legal lift
and what is not acceptable. A non-sanctioned meet. We will follow the
USAPL guidelines. We will follow all Christian principals
http://www.usapowerlifting.com/wp-content/uploads/2014/02/USAPLRulebook-2013_1.pdf
Direct questions to:
YMCA: 369-9622, ext. 32 www.altavistaymca.com
111237 04/12
Altavista YMCA Push/Pull
REGISTRATION/WAIVER
Please Print
Name of Participant (First and Last):
T-Shirt size:
Street Address:
City:
State:
Phone:
Zip:
Event:
Email (Print clearly to sign up for our newsletter):
Emergency Contact Name:
Phone:
INFORMED CONSENT FOR PUSH/PULL PARTICIPATION
I desire to engage voluntarily in Altavista YMCA Push/Pull organized by the Altavista YMCA, Don
Reagan, Trevor Vasser, and Derick Simpson in Altavista, VA. I understand that this activity is
designed to test the strength and power capacity of the body. I understand that I am responsible
for monitoring my own condition throughout the competition and should any unusual symptoms
occur, I will cease my participation and inform the staff of the symptoms.
In signing this consent form, I affirm that I have read, accept and understand this form in its
entirety and that I understand the nature of this event. I know that there may be risks associated
with maximal strength testing and willingly accept those possibilities. I know that it is my
responsibility to ensure my own safety. I take full responsibility for my own health and safety in
participating in Altavista YMCA Push/Pull and to the extent I deem advisable, will consult a
physician before participating in any of the activities. I agree to pay all reasonable costs related to
the Altavista YMCA Push/Pull, including any medical costs I incur.
AGREEMENT AND WAIVER/RELEASE OF LIABILITY
In consideration for being allowed to participate in this activity, which I do freely and voluntarily
for my own personal benefit, I hereby take action for myself and assigns to:
1. Waive, release and discharge from any and all liability to the Altavista YMCA, Don Reagan,
Trevor Vasser, Derick Simpson, and other staff for my death, disability, personal injury,
property damage, or property theft, or actions of any kind which may hereafter accrue to
me.
2. Indemnify and hold harmless Altavista YMCA, Don Reagan, Trevor Vasser, Derick Simpson,
and other staff from any and all liabilities or claims made by other individuals or entities as
a result of or relating to my participation in this activity.
Therefore, intending to be bound and as a condition of being allowed to participate in the Altavista
YMCA Push/Pull, I have freely signed this waiver on the date indicated.
Participant Signature:
Parent/Guardian Signature (Required if under 18 years old):
Print Parent/Guardian Name:
Date: