Registration Form for Presidential Physical Fitness Test Sunday, October 4, 2009:
Participant Information: First Name: ____________________________________ Last Name: ____________________________________ Age on October 4, 2009: ________ Birthdate:____________________________ School: ____________________________________ Parent Name: ____________________________________ Parent Signature: ____________________________________ Phone Number: ____________________________________ Indicate whether your child has a medical issue that may prevent him/her from participating in one or all of the events. _________________________________________________________________________ _________________________________________________________________________ Note that this is not a “drop off” event – a parent or other authorized adult must remain with each participant throughout the events and remains responsible for the decision to participate or to continue participating. Authorization and Release I hereby give my consent for the administration of First Aid to my child, transfer of my child to a nearby Hospital, and the administration of emergency medical treatment deemed necessary by the staff of such hospital. I hereby release all sponsors and individuals involved with this event from liability for actions that may be taken as a result of this authorization. If you wish your child to receive emergency medical treatment, please sign. _________________________________ Signature Parent/Guardian Please send this registration and authorization to:
2009 Presidential Physical Fitness Challenge VFW PO Box 402 Hingham, MA 02043 Or scan and email to: dan.evarts@gmail.com Or fax to: Dan Evarts @ 508-256-8374