LV’S CHEETAHS

HANDS OFF AND SEE ME FLY

Mail along w/ fees to:

Lavon Burks

15662 South Spaulding

Markham, IL

60428

Individual Entry Form

Personal Information

Athlete Sex (Circle One): M F U S A T F #:______________________

First:_________________________________ Birth date: _______________________

Last:_____________________________________________________________________

Address:__________________________________________________________________

City:____________________________ State:_____________ Zip:__________________

Phone: (________)_________________ Alternate Phone: (_______)__________________

Email Address:____________________________________________________________

Event Best Outdoor Performance

__________________________________ _______________________________

__________________________________ _______________________________

__________________________________ _______________________________

__________________________________ _______________________________

Important—Release Statement:

I understand that competing in this event is potentially dangerous. I hereby waive and release USATF/TFS High School from any and all liability for any injuries or illnesses incurred while participation in the aforementioned meet. I have no knowledge of any physical impairment that would be affected by the above athlete’s participation in this meet.

Parent /Guardian Signature:__________________________________________________________________________

Entries:

List the events in which you would like to be entered and best outdoor seed mark.