Track Registration 2014
TRACK (4th-8th Grade)
REGISTRATION DUE FRIDAY, APRIL 4TH.  LATE REGISTRATION CAN NOT BE GUARANTEED.

The 2014 Track and Field season will begin on April 21st and end on May 28th.  Practices and meets will be held on Mondays and Wednesdays from 6:00-7:30 (except Tuesday, May 27th).   Events will take place at M-A High School, except May 12 and 14 which will take place at Hillview Middle School in Menlo Park.  Parents/guardians will be responsible for transportation to and from all practices and meets.  

Event dates: Mon/Wed April 21/23/28/30 May 5/7/12/14/19/21/23/28 andTues May 27 (since no program on Memorial Day May 26)

The Track and Field program is very low-key in nature and focuses on personal best, not winning.  Athletes will have opportunities to participate in sprints, distance runs, hurdles, relays, long jump, high jump, shot put, discus and plastic javelin.  The program is run in conjunction with La Entrada, Hillview and Woodside Elementary.  All 4 schools will be at the practices and meets in order to maximize the events offered each time.  

Please contact Kate Cox if you have questions about Track at kcox@pvsd.net.


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Student Name *
First and Last Name
Grade *
Shirt Size *
Address *
Street, City, ZIP
Parent/Guardian Information
Mother *
First and Last Name
Cell Phone *
Please include area code.  Insert N/A if not applicable.
Home Phone *
Please include area code.  Insert N/A if not applicable.
Work Phone *
Please include area code.  Insert N/A if not applicable.
Email address *
Father *
First and Last Name
Cell Phone *
Please include area code.  Insert N/A if not applicable.
Home Phone *
Please include area code.  Insert N/A if not applicable.
Work Phone *
Please include area code.  Insert N/A if not applicable.
Email address *
Emergency & Health Information
Emergency Name *
First and Last Name-Additional person if parent can not be contacted.
Emergency Contact Phone *
Please include area code.
Health Insurance Carrier *
Group/ID Policy # *
Waiver
The following Waiver is required for Participation.  Without exception, failure to sign will preclude participation.  Permission slip for Participation in After-School Sports sponsored by PV-PTO.

I want my daughter/son/legal charge to participate in the Corte Madera After–School Track Program.

1. I FULLY UNDERSTAND THAT THIS ACTIVITY CAN BE DANGEROUS and that my daughter/son/legal charge could be injured, even if the activity is conducted with due care by all concerned.

2. I AM FULLY AWARE OF THE RISKS and hazards inherent in my daughter/son/legal charge engaging in this activity and I voluntarily elect, both on my behalf and on behalf of my daughter/son/legal charge to have her/him engage in that activity, that the activity is such that my daughter/son/legal charge may be injured even if the PV-PTO and utilize due care. I also know that the PV-PTO, is not a guarantor of my daughter/son/legal charge’s safety and financially could not conduct this activity if it bore the risk or injury or death arising out of same. I THEREFORE VOLUNTARILY ASSUME ALL RISKS OF LOSS, DAMAGE, INJURY OR DEATH to my daughter/son/legal charge arising out of her/his participation in this activity.

3. It is my intent by this clause to exempt and to relieve the PV-PTO, its officers and agents, from any and all liability for personal injury, wrongful death or property damage arising out of my daughter/son/legal charge involvement in this activity.

4. I further agree to indemnify and hold harmless the PV-PTO, its officers, agents, employees, and representatives from and against all death, injuries, damages, whether incurred by judgment or settlement, including legal expense and attorney’s fees, of whatever nature occurring during, by reason of, or arising out of
my daughter/son/legal charge’s participation in said activity, and I shall assume the defense and/or settlement of any claim, suit or action brought against the PV-PTO or its officers, agents, employees or representatives to recover any such damages.

5. Further, on behalf of myself, my daughter/son/legal charge, and our personal representatives, assigns, heirs, and next of kin, I HEREBY RELEASE, WAIVE, DISCHARGE, AND COVENANT NOT TO SUE the PV-PTO, its officers, employees, agents or representatives for loss or damage and any claims or demands therefore on account of injury or death to my daughter/son/legal charge, whether caused by negligence of the PV-PTO, or their employees or volunteers, where such injury or death occurs during, by reason of or arising out of this activity.
Electronic Signature *
Selecting "Yes" will serve as my authorization and signature.
Required
Signature Date *
Thank You!
To complete the registration process, the fee of $175 must be submitted to PV-PTO by Friday, 4/4.  You can PAY VIA PAYPAL or submit a check made payable to PV-PTO.  All checks can be submitted to the envelope in the CMS office.  

To submit an electronic payment, please click the link on the confirmation page that follows. You may also access the page by copying and pasting this link: http://pvsd.net/Page/333

Students will not be denied the opportunity to participate should they not be able to pay any or all of the registration fee.  Outreach assistance form available on the payment page.  

Please contact Kate Cox (kcox@pvsd.net) if you have any questions.
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