You are on page 1of 1

For day-of registration, please arrive at 10am.

Mail: Sen. Adriano Espaillat, attn: David Baily, 5030 Bway, #701 NYC 10034
Fax: 212-544-0256 E-mail: eventsRSVP@adrianoespaillat.org

Date
th

Saturday, March 28 , 2015


10:00am-3:30pm

Step

Place

Time

New Balance Track & Field Center


at the Armory
216 Ft. Washington Ave.
th
th
(btw W. 168 & W. 169 )
th
A, C or 1 train to 168 St.

Doors open at 10:00am


Same-day registration
closes at 11:00am.

Fill in your childs information

Games begin at 11am

(please print)

Name of Youth (First) ____________________________ Last ______________________ boy girl


Date of Birth __________________________________

Grade on Race Day _______________________

Your e-mail________________________________ Emergency contact phone # _____________________


School Name ____________________________________________________________________________
Is your child attending as part of a school team _________________________, or as an individual _____?
(name of team)

T-shirt size:

Youth Sm _____ Youth Med _____ Youth Lg _____ Adult Sm _____ Adult Med _____

Step

Parent or Guardian read waiver and sign.

I think that there are inherent risks and potential for injury when participating in an event such as the Uptown Games, including but not limited to
falls, contact with other participants or spectators, effects of weather, conditions on the track or surrounding areas, and physical exertion, and I
hereby assume all such risks and responsibility for any and all injury, damage or loss that may result from participation in the Uptown Games. I
represent that my child is physically fit to participate in the Uptown Games, and is not subject to any medical condition that poses any risk of harm
to him/herself or others. I, for myself, my child, and anyone entitled to act on our behalf, do hereby release the New York Road Runners, Inc., the
Armory Foundation, the City and State of New York and its agencies and officials, and all other sponsors of the Uptown Games and the
representatives and successors of all of the foregoing, from any and all present and future claims and liabilities of any kind, known or unknown,
arising out of my childs participation in the Uptown Games. I grant permission to the foregoing persons and entities to use or authorize others to
use any photographs, motion pictures, recordings, or any other record of my or my childs participation in the Uptown Games or related activities
for any legitimate purpose without remuneration.

Parent/Guardian Signature _____________________________________________

Senator
Adriano Espaillat

Councilmember
Ydanis Rodr iguez

Date ________________