PoleVaultPower.com

4th Annual Vaultober on Saturday Oct 20,2012 at 1:00pm at Oral Roberts University!

Come join the ORU track and field team for a fun-filled day of vaulting in your
favorite costume! Event will have prizes, contests and more!

When: Saturday October 20, 2012
Time: Registration begins at 11:00am
Competition begins at 1:00pm
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)
http://www.facebook.com/events/41989282 ... tif_t=like


2012 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 Coach Shawn Venable at 918-902-2913

I am ready.

Correction made to the itinerary: Registration begins at 11:00am, Competition begins at 1:00pm. Thanks for the heads up Kevin.