Memorial Middle School

Track and Field 2009

Information Sheet

Name: __________________________ School: _________________________________

Grade: __________

Home Phone Number: ___________________

Cell Phone Number:

E-mail Address: ___________________

T-shirt size: _____________

Have you run track before? Yes No

If yes, how many years? _______

What other sports have you participated in?

Sport Years

____________________ ________

____________________ ________

____________________ ________

____________________ ________

What events are you interested in?

Sprints (100m, 200m) _____ Hurdles (100m / 110m LH) _____ 400m Relay _____

Middle Distance (400m, 800m) _____ Distance (1600m) _____ 800m Relay _____

Shot/Discus _____ High jump _____ 1600m Relay _____

Long jump _____

Do you have any health problems? Yes No

If yes, please list

Please list any individual accomplishments (academic or extra-curricular), clubs, and/or organizations that you are involved with.

_________________________________________________ __________________________________________________

_________________________________________________ __________________________________________________

Parent Signature: _____________________________________________