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

Icahn Stadium, Randall’s Island

4, 5, or 6 train to 125th St., transfer on the NW corner of 125th St.
and Lexington Ave. for the M35 bus to Randall’s Island and Wards Island

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

or call 646.758.9675.

FREE FOR ALL!

Friendly, fun competition for kids ages 4-15, all athletic levels welcome.
No spikes allowed.
No hard coolers will be permitted inside the stadium.
 ALL EVENTS ARE BOYS AND GIRLS • NO SPIKES PERMITTED
ONLY TWO EVENTS PER PARTICIPANT • SCHEDULE SUBJECT TO CHANGE

Qualifying times: Boys 2:35 Girls 2:45

Sunday,
May 15, 2011

Qualifying event for “Fastest Kid Race”

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

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

 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

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.

Date:
An individual or family
Child(ren) attending as
A member of
(circle one):
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 location):

Name of Site Coordinator/Coach (if you

are part of a school or team):

Name of person submitting this form (if not

Site Coordinator/Coach):

E-mail and phone number:

Total number of registration forms

submitted with this checklist form:

Comments:

Make sure every registration form is completely filled in and signed by a parent or guardian.
A Site Coordinator or Coach signature will not be accepted.
 Run for it! Return this form to pre-register by 5/6/2011.
For day–of registration, please arrive at least one hour prior to your first 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

Date Place Time

Icahn Stadium Races begin at 9:00 a.m.
Sunday, May 15, 2011
Take the 4, 5, or 6 train to 125th St., transfer on Youth ages 5-10 race 9:00 a.m. – 12:00 p.m.
Registration begins at 7:45 a.m. the NW corner of 125th St. and Lexington Ave. *4 year old 55-Meter at 12:30 p.m.
for the M35 bus to Randall’s and Wards Island. Youth ages 11-15 race 1:00 p.m. – 4:00 p.m.

Step 1 Fill in your child’s information (please print)

Name of Youth First Last Boy Girl
Date of Birth Age on Race Day
E-mail Emergency Contact Phone #
Are you attending as:
An individual or family School name Borough/Location
A member of a Mighty Milers site School name Borough/Location
A member of a Young Runners team School name Borough/Location
A member of an unaffiliated team Team name Borough/Location

Step 2 Parent or Guardian read waiver and sign

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
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trained. I agree with participating
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and all other and all sponsors, and their representatives
and the representatives and successorsandof all of
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foregoing, fromfromallallpresent
present and
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future claims
claims andand liabilities
liabilities ofkind,
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I grant
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persons and entities
and entities to usetooruse or authorize
authorize othersothers
to use to
anyuse any photographs,
photographs, motion motion
pictures,pictures, recordings,
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or any other other
record ofrecord of my
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child’s child’s participation
participation in this event or
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any legitimate for anywithout
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Parent/Guardian Signature Date

Coach’s signature not accepted.

Step 3 Choose TWO of the following events

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 -15
Note: Relay teams must register all four runners together. Relays count as one out of two events.
800-Meter Invitational Ages: o 10 -12 ONLY Qualifying Times: BoySsGirls 2:45
†
Qualifying event for “Fastest Kid Race” held at adidas Grand Prix on 6/11/2011