JPRD LOCAL TRACK MEET
Children ages 5 to 14 are eligible to participate in the JPRD Local Track meet on Thursday, April 27,
2017(rain date is May 4, 2017) at Linduska Field. Participants in the 7-14 year old divisions will be
eligible to compete at the State Track meet on June 11 at Marshalltown. Participant’s age is as of
December 31, 2017. Mini Track participants are encouraged to participate. Event is FREE for all
participants. See more information below!
(Please print clearly)
FULL NAME:_____________________________________________________________________
ADDRESS:_______________________________________________________________________
CITY:_______________ STATE/PROVINCE:____________ ZIP/POSTAL CODE:______________
TELEPHONE:_____________________ Parent / Guardian E-mail:__________________________
Date of Birth: Month________Day______Year_________
________________________________________________________________________________________________________________________________________________________________________________________________________________________
Participants can enter either two track and one field or two field and one track event up to and including the State Final.
Please circle the events you wish to participate in at this meet.
**Exception: 7-14 year olds CAN participate in a relay as well as the three events for a total of 4 events due to those age group.
Participants must organize own relay team. **
________________________________________________________________________________________________________________________________________________________________________________________________________________________
Boys 7-8 (Born in 2008-2009)
Boys 11-12 (Born in 2004-2005)
1.
50 Meter Dash
1.
100 Meter Dash
2.
100 Meter Dash
2.
200 Meter Dash
3.
200 Meter Dash
3.
400 Meter Dash
4.
* 4 x 100 Meter Relay
4.
800 Meter Dash
5.
Standing Long Jump
5.
* 4 x 100 Meter Relay
6.
Softball Throw
6.
Standing Long Jump
7.
Softball Throw
Boys 9-10 (Born in 2006-2007)
Boys 13-14 (Born in 2002-2003)
1.
50 Meter Dash
2.
100 Meter Dash
1.
100 Meter Dash
3.
200 Meter Dash
2.
200 Meter Dash
4.
400 Meter Dash
3.
400 Meter Dash
5.
* 4 x 100 Meter Relay
4.
800 Meter Dash
6.
Standing Long Jump
5.
1600 Meter Dash
7.
Softball Throw
6.
*4 x 100 Meter Relay
7.
Standing Long Jump
8.
Softball Throw
Girls 7-8 (Born in 2008-2009)
Girls 11-12 (Born in 2004-2005)
1.
50 Meter Dash
1.
100 Meter Dash
2.
100 Meter Dash
2.
200 Meter Dash
3.
200 Meter Dash
3.
400 Meter Dash
4.
Standing Long Jump
4.
800 Meter Dash
5.
Softball Throw
5.
* 4 x 100 Meter Relay
6.
Standing Long Jump
7.
Softball Throw
Girls 9-10 (Born in 2006-2007)
1.
50 Meter Dash
2.
100 Meter Dash
3.
200 Meter Dash
1.
100 Meter Dash
4.
400 Meter Dash
2.
200 Meter Dash
5.
*4 x 100 Meter Relay
3.
400 Meter Dash
6.
Standing Long Jump
4.
800 Meter Dash
7.
Softball Throw
5.
1600 Meter Dash
6.
* 4 x 100 Meter Relay
7.
Standing Long Jump
8.
Softball Throw
Girls 13-14 (Born in 2002-2003)
•
Early Registrations Appreciated
•
Registrations can be returned to the GCCC, 204 W. Harrison St, Jefferson
•
Local Meet: Thursday, April 27, Check in: 4:30 pm, Meet starts: 5:00 pm
•
Location: Linduska Field (GC Track), 101 Ram Drive, Jefferson, IA
•
Questions: Please call 386-3412 or email [email protected]
Relay Team (circle age)
Boys: 9-10 (born in 2006-2007)
11-12 (born in 2004-2005)
13-14 (born in 2002-2003)
Girls 9-10 (born in 2006-2007)
11-12 (born in 2004-2005)
13-14 (born in 2002-2003)
1. _________________________________
2. _________________________________
(First Name) (Last Name)
(First Name) (Last Name)
3. _________________________________
4. _________________________________
(First Name) (Last Name)
(First Name) (Last Name)
REGULATIONS
Eligibility
Name of School/Community:________________________________________________________________
City, State/Province:_______________________________________________________________________
*Age as of December 31, 2017:______________________________________________________________
 Copy of legal birth certificate included with registration. This will be used to verify age and is needed for child to
participate at the state level. All birth certificates are properly disposed of following track meet.
 Yes! I, ___________________________, am interested in helping at the Jefferson Hershey Track Meet.
*All participants must compete in their age group and sex division.
PARENT/GUARDIAN CONSENT:
Emergency Information: _________________________________________________________________________
Mother and Father or Guardian’s Name
Emergency number other than that listed (A close relative to be notified):___________________________________
The above named participant and the participant’s parent/guardian have requested registration of the participant in the Hershey’s Track & Field
Games. In consideration of such registration, the right of the participant to compete in the Hershey’s Track and Field Games and the use by the
participant of the sponsoring agency’s facilities and equipment, both the participant and the parent/guardian each acknowledge that the
participant will be competing in the Hershey’s Track and Field Games and sponsoring agency’s facilities at the participant’s sole risk and the
participant, on his or her own behalf and on the behalf of his or her heir, executors, administrators and assigns hereby release, discharge and
agree to hold harmless The Hershey Company and its franchises and the National Recreation and Park Association, USA Track & Field and
Athletics Canada. We understand that those participants who advance to the state/provincial level and are winners at this level
do not automatically advance to the regional level for the North American Final Meet. This is covered under Rule 9, Article 1
in the rule book. We also agree to allow the Hershey’s Track & Field Games to use and reproduce the participant’s name and/or likeness
and/or information concerning the participant and to circulate the same for any and all purposes in any manner. We certify that the information
on this participation form is correct.
_________________________________________________________
________________________________________________________
Signature of Parent or Guardian
Date
125250A JPRD Local Track Meet
FREE