Staff: th 10 Annual “Rodeo” Roy D. Willits, Coach Mt. Athlete Name: View, Tucson (17 years). Pole Vault Clinic J. Croissant, Coach Salpointe CHS, Tucson (10 years) When: Saturday February 20, Age:__________/Year in School:_______ Other staff may include: James 2010, 8:30am-4:30pm. Truitt, CDO, and other local Address:___________________________ Where: Canyon Del Oro HS. coaches. Canyon del Oro High School __________________________________ Equipment: 25 W. Calle Concordia, Tucson, AZ Athletes need to bring appropriate Phone Number:_____________ 85737. Just west of Rte. 77/Oracle Road. workout clothes (dress warm!), running shoes and spikes, poles if at all High School/Coach:__________________ Who: All vaulters or potential possible. We will provide water, pole vaulters, age 10 and over, any vault pits, some poles, and other Height/Weight:___________/__________ level of experience. equipment for vaulting drills. Number of Years Vaulting: 0 1 2 3+ Cost: $40 for registrations Schedule: postmarked by 2/5 or called in by 8:30 Registration Current PR:_______________ 2/6 (Wednesday), $50 for late or 9:00 Vault Session walk-in registration. 12:00-1:30 Lunch Fill out this form, and sign the back, 1:30-4:30 Vault Session and send with checks payable to Lunch IS included. Contact us for Pole Pilots Track Club: team discounts. pole pilots track club R. D. Willits, J. Croissant. pole pilots track club http://www.polepilots.org Contact us at: 520-206-9322 R. D. Willits, J. Croissant. (voicemail), or email@example.com. 1137 E. Edison Street 1137 E. Edison Street Tucson, AZ 85719 Tucson, AZ 85719 Camps are an invaluable way to learn I hereby grant permission for myself/child to attend the Pole Pilots Pole Vault Clinics. I the pole vault. In a focused environment surrounded by other pole pilots track club verify that I/my child had a physical exam in the last year and am/is capable of participating vaulters, you can really learn the event Roy D. Willits, J. Croissant. in the activities related to pole vaulting. I agree effectively. Contact us at: 520-206-9322 to indemnify, hold harmless, and defend Jen (voicemail), or firstname.lastname@example.org. Croissant, Roy D. Willits, Jr., Pole Pilots, CDO 1137 E. Edison Street High School, USAT&F, their agents, We at Pole Pilots are committed to safe Tucson, AZ 85719 employees, and sponsors from any and all instruction in vaulting fundamentals, liability for injury to myself/child. I understand and to providing techniques and that track and field and in particular pole strategies for long-term success in this, We are Tucson’s only pole vaulting vaulting and many of its related activities are and other track and field events. club! Recent alumni include: potentially dangerous and could pose risk of injury. Should medical attention be necessary, Besides clinics we hold regular I hereby authorize any physician or trainer Connie Jerz, Tucson High 2000 workouts for our vaulters. Contact us selected by club personnel to conduct medical, 5A State Champ, former 5A State Record for more information! (12’2-1/2”). USATF Jr. All-American, U of A, first aid, or surgical procedures. 2003 NCAA Outdoor Runner Up, PR 14’1-1/2” I have read and understood, and I agree with Colin Witter-Tilton, Ironwood Ridge 2006 the informed consent and release outlined Support your local Pole Vaulters: above as it relates to myself/son/daughter. 4A State Champ, PR of 16’1, now jumping at http://www.polepilots.org the University of Oregon. Caitlin Clancy, CDO 2006, Participant’s 4A State Champ, PR of 12’, now jumping at signature:________________________ the University of Tulsa. Date:___________________ Martin Nevarez, Casa Grande HS 2006 5A State Champ, PR of 15’7, now jumpin gat Casa Grande Community College. Parent/Guardian’s signature:________________________ Erin Anderson, Mountain View 2001. PR of 13’3 at the University of Arkansas, formerly Date:___________________ NJCAA Champ for Paradise Valley CC with a PR of 12’7 and a 4A HS state Champ with a PR of 12’1.