2nd Annual Vaultober

Come join the ORU track and field team for a fun-filled day of vaulting in your
favorite costume, prizes, contests and more!
 
When: Saturday October 23, 2010
Time: Registration begins at 2:00pm
          Competition begins at 3:00pm
Where: H.A. Chapman Baseball Facility
Oral Roberts University
               7777 South Lewis Avenue, Tulsa, OK, 74171
- Located just north of the ORU baseball stadium.
 
 
$25 Registration Fee – Check or Cash

Send Payment and Completed forms to:
       Oral Roberts University
ATTN: Joe Dial Track & Field
       7777 South Lewis Avenue
       Tulsa, OK 74171
     
 
**Register before OCTOBER 1st and have your name entered into the raffle drawing for
one of our many PRIZES!
 
 
 
(Additional details on Facebook event page)
 
 
 
2010 Costume Vault Registration Form
 
Name: _______________________________
M         F                      Age: _________
Street Address: ___________________________
City: ___________________________
State: __________Zip: _____________
DOB: _____/______/______
 
Any medical concerns we should be aware about?
__________________________________________________________________________________
 
Parent’s or Legal Guardian’s Name: _______________________________
Phone Number: _______________________________
 
Current School Attending: ______________________________
Grade: ______________________________
Personal Record: ______________________
Costume:______________________________________________________________
Favorite Vaulter: ___________________________________
Any specific goals in mind for your future in vaulting or school:
__________________________________________________________________________________
 
 
 
 
 
 
 
 
 
 
 
 
 
Risk Acknowledgement
 
To the Parents or Guardians:
 
I _______________________________ acknowledge and know that there is risk involved
in the pole vault and that it is a potentially hazardous activity. I understand that
the ORU Track and Field team will take precautions to minimize that potential.  I do
hereby waive, release and discharge all claims of whatsoever kind which I may have,
or which may hereafter arise against ORU, its proprietors, its agents or employees.
 
Parent Signature ____________________________________
Date ____________________________
 
 
Emergency Treatment
 
In order for your child to receive prompt medical treatment in the event of an
accident during pole vault camp, we at ORU require that we have on hand a signed
statement allowing your son or daughter to be treated in emergency situations. In
all situations that may occur you will be contacted and informed of any treatment
that is being done. Please provide us with a contact phone number where you can be
reached.
 
In event of my son or daughter _____________________________________ is injured and
in need of emergency medical treatment, I hereby give permission for such treatment.
 
Parent signature _______________________________________________
Home _______________________________________________________
Cell _________________________________________________________
Work ________________________________________________________
Insurance Company ____________________________________________
Policy number _________________________________________________
 
Emergency person if you can not be reached
Name ________________________
Phone ________________________
 
 
Any questions please call: 918-495-6839 or 918-557-9754
jdial@oru.edu  or sdial@oru.edu