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Sunday, May 15, 2011, 7:45 a.m. - 4:00 p.m.

For more information visit www.nyrrf.org, e-mail jamboree@nyrr.org,

or call 646.758.9675.

Friendly, fun competition for kids ages 4-15, all athletic levels welcome.

No spikes allowed.

No hard coolers will be permitted inside the stadium.

FREE FOR ALL!

Icahn Stadium, Randalls Island4, 5, or 6 train to 125th St., transfer on the NW corner of 125th St.

and Lexington Ave. for the M35 bus to Randalls Island and Wards Island

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Sunday,May 15, 2011

4 year old 55-Meter at 12:30 p.m.

A L L E V E N T S A R E B O Y S A N D G I R L S

N O S P I K E S P E R M I T T E DO N L Y TWO E V E N T S P E R P A R T I C I P A N T S C H E D U L E S U B J E C T T O C H A N G E

Qualifying times: Boys 2:35 Girls 2:45

Qualifying event for Fastest Kid Race

held at the adidas Grand Prix on 6/11/2011

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845 Third Avenue, 11th floor

New York, NY 10022

jamboree@nyrr.org

Phone: 646.758.9675

Fax: 917.677.8939

Youth Jamboree Registration Checklist Form

Date:

Child(ren) aending as

(circle one):

An individual or family

A member of

A member of

A member of a team unaffiliated with New York Road Runners

School name and borough (if not a school,

write team name and locaon):

Name of Site Coordinator/Coach (if you

are part of a school or team):

Name of person subming this form (if not

Site Coordinator/Coach):

E-mail and phone number:

Total number of registraon formssubmied with this checklist form:

Comments:

Please include this form as the first page of each submission of a registration form(s) via E-mail (scanned

document, less than 10 mb), fax, postal, or in-person delivery. NYRR will send a confirmation of receipt E-mail, within 2

business days, for all registration forms submitted via E-mail or fax. If you do not receive a confirmation E-mail, please

re-send your form(s). The pre-registration deadline is 5/6/2011. Other deadlines may apply if the participant is part

of one of our programs. Please bring a copy of all registration forms with you on the day of the Jamboree.

Make sure every registraon form is completely filled in and signed by a parent or guardian.

A Site Coordinator or Coach signature will not be accepted.

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Run for it! Return this form to pre-register by 5/6/2011.

Are you attending as:

E-mail

Date o Birth Age on Race Day

Emergency Contact Phone #

Name o Youth First Last Boy Girl

55-Meter Dash

Ages: o 4*

100-Meter Dash Ages: o 5 - 6 o 7 - 8 o 9 - 10 o 11 - 12 o 13 -15

200-Meter Dash Ages: o 5 - 6 o 7 - 8 o 9 - 10 o 11 - 12 o 13 -15

400-Meter Dash Ages: o 11 - 12 o 13 -15

Long Jump Ages: o 5 - 6 o 7 - 8 o 9 - 10 o 11 - 12 o 13 -15

Shot Put Ages: o 5 - 6 o 7 - 8 o 9 - 10 o 11 - 12 o 13 -15

4x200-Meter Relay Ages: o 5 - 6 o 7 - 8 o 9 - 10 o 11 - 12 o 13 -15Note: Relay teams must register all four runners together. Relays count as one out of two events.

800-Meter InvitationalAges: o 10 -12 ONLY Qualifying Times: BoyGirls 2:45

Qualifying event for Fastest Kid Race held at adidas Grand Prix on 6/11/2011

Coachs signature not accepted.

Parent/Guardian Signature Date

For dayo registration, please arrive at least one hour prior to your frst event.

E-mail: jamboree@nyrr.org (as a scanned document, less than 10 mb)

Fax: 917.677.8939

Mail: Attn: Jamboree, 845 3rd Ave., 11th Floor, New York, NY, 10022

Step 1 Fill in your childs information (please print)

Step 2 Parent or Guardian read waiver and sign

Step 3 Choose TWO of the following events

An individual or amily School name

A member o a Mighty Milers site School name Borough/Location

A member o a Young Runners team School name Borough/Location

A member o an unafliated team Team name Borough/Location

Sunday, May 15, 2011

Registration begins at 7:45 a.m.

Races begin at 9:00 a.m.Youth ages 5-10 race 9:00 a.m. 12:00 p*4 year old 55-Meter at 12:30 p.m.

Youth ages 11-15 race 1:00 p.m. 4:00 p

PlaceDate Time

I know that participating in New York Road Runners events is a potentially hazardous activity. My child should not enter and participate unless medically able and properly trained. I agree to abide by any decis

o an event ofcial relative to my childs ability to saely compete in the event. My child is voluntarily entering, and we assume all risks associated with participating in the event, including, but not limited

alls, contact with other participants, spectators or others, and the conditions on the track and surrounding areas, all such risks being known and appreciated by us. Having read this waiver and knowing th

acts, and in consideration o your acceptance o this application, I, or mysel, my child, and anyone entitled to act on our behal, waive and release New York Road Runners, Road Runners Club o Ame

USATF, USATF - Metropolitan, Icahn Stadium, Randalls Island Sports Foundation, the City o New York, Department o Parks & Recreation, and all other sponsors, and the representatives and successors o a

the oregoing, rom all present and uture claims and liabilities o any kind, known and unknown, arising out o my childs participation in this event or related activities, even though such claim or liability

arise out o negligence or ault on the part o any o the oregoing persons or entities.

I grant permission to the oregoing persons and entities to use or authorize others to use any photographs, motion pictures, recordings, or any other record o my or my childs participation in this eve

related activities or any legitimate purpose without remuneration.

Borough/Location

Icahn StadiumTake the 4, 5, or 6 train to 125th St., transer onthe NW corner o 125th St. and Lexington Ave.or the M35 bus to Randalls and Wards Island.