Moorestown Track & Field Camp

							6th Annual World Athlete Indoor Track Programs
      Moorestown Athletic Center (behind Moorestown HS)

                                Track and Field Training Clinics
                                      January 4, 11 &18
                                       6:30pm-8:15pm

                        Track Meets (Now there are 3 meets!)
                         January 25, February 1, February 8
                     6:15pm-9:00pm (Check-in starts at 5:30pm)

         World Athlete Indoor Track Academy - for children 3-14
        includes 3 training clinics and 3 track meets for only $139
             Each athlete gets a Dri-FIT World Athlete t-shirt.
        Registration deadline: December 20, 2011. Register today!

        World Athlete Indoor Track Meets - for children 3-14
    Can’t do the entire track academy? Come to the track meets!
    Entry fee: $12 per meet     Enter as many events as you like.
  40M 200M 400M 800M Mini Hurdles Relays 3lb Shot Put Jumps
                     Preregistration for the meets is strongly suggested

World Athlete promotes fitness and healthy lifestyles through the sport
of track and field. All skill levels are welcome! Children are coached in
sprinting, hurdling, jumping, relays, throwing events and conditioning.
 Thousands of children have participated in World Athlete indoor and
   summer track. For more information, visit www.worldathlete.net

          Registration form on the other side of this flyer
  609-304-2902   coach@worldathlete.net      www.worldathlete.net

                  EVERYONE WINS AT WORLD ATHLETE!
 The Moorestown Township Board of Education does not necessarily sponsor or endorse the contents of this notice or the
                              organization responsible for disseminating this notice.
WORLD ATHLETE REGISTRATION                                                        Referred By:
Name           ______________________________________________________ Age ___                  School __________________

Name           ______________________________________________________ Age ___                  School __________________

Name           ______________________________________________________ Age ___                  School __________________

Address        __________________________________________________________________

City           ________________________________                State _____     Zip ___________


Home Phone _______________________             Email __________________________________________________________

Parent/Guardian Name           __________________________________________            Cell #: __________________________

Emergency Contact Name         __________________________________________            Phone #: ________________________

RELEASE:
I certify that my child is in excellent health and may participate in strenuous activities including track and field. I agree
to hold World Athlete, LLC, its coaches, staff, volunteers, World Athlete Academy, Moorestown Township Public
Schools and the Township of Moorestown harmless from any and all claims of injuries sustained by my child during
his/her participation in the Academy. Permission is hereby granted to World Athlete, LLC to use pictures of
participants in any promotional materials. Permission is hereby granted for my child to receive medical treatment if
needed. I certify that there are no limits on my child’s participation except as stated in writing and included with this
release form.

Parent/Guardian Signature ________________________________ Date ______________zas

FOR INDOOR TRACK ACADEMY (includes 3 training sessions and 2 track meets):

       REGISTRATION FEE: _____ Athletes        @ $139.00 each                                  = $ ________
       SPECTATOR FEE:    _____ Spectators x $3.00 x ___ # of meets                             = $ ________
                                Under age 12 free
       DONATION:         World Athlete Foundation promotes youth track & field                 = $ ________
                                                      TOTAL PAYMENT:                             $ ________

FOR TRACK MEETS ONLY (for children not enrolled in the indoor track academy):

       ATHLETE ENTRY FEE:          _____ Athletes x $12.00 x ___ # of meets              = $ ________
                                   _____ Athletes under 5 x $8.00 x ___# of meets         = $ ________
               Team Discount: $10.00 per Athlete for any team that registers 10 or more children


       SPECTATOR FEE:                 _____ Spectators x $3.00 x ___ # of meets                = $ ________
                                             Under age 12 free
       DONATION:               World Athlete Foundation promotes youth track & field           = $ ________

                                                               TOTAL PAYMENT:                    $ ________

PAYMENT OPTIONS:
1) Make your check/money order payable to:                     3) Online registration at www.worldathlete.net
       World Athlete Track Academy
        Mail checks to:                                        4) Cash accepted on-site for track meet registration
        World Athlete Track Academy
        4 Marcy Court
        Mt. Laurel NJ 08054

2) Credit Cards Accepted: MasterCard, Visa and Discover
       Card #: ____________________________________            Exp. Date (MM/YYYY) _______
       Signature __________________________________            Date _____________________

                Academy Cancellation and Refund Policy can be found on worldathlete.net