Air Power Gamesâ - Registration Form

Mail the completed form and check in a stamped envelope to:  Dr. James Davis,  Department of Kinesiology, California State University, Long Beach, CA 90840-4901.  Please make checks payable to CSULB Foundation.  At least one parent/guardian is expected to accompany the child to the Air Power Games^®.

Child’s name:  ________________________________________________________________________

Attending Parent(s)/Guardian(s) Name(s): __________________________________________________

Address: _____________________________________________________________________________

City: _______________________________________________      Zip____________________________

Phone (day): _________________________ Phone (message): _________________________________

Sex:  M   or   F  Child’s Birthdate: ________________ Age on Day of Air Power Games® ___________  

           $ 5   Pre-registration                          $ 10    Post- registration

** Scholarships are available – please call (800) 624-0044 if interested. **

Please circle events your child would like to participate in.

Obstacle run                 Long Jump        Shot Put            High Jump        Softball Throw

50 meter dash               100 meter dash              200 meter dash             400 meter dash 

(Restricted to registered athletes)

1.   I, __________________________, hereby grant to CSULB and the Asthma & Allergy Foundation of America, its constituents and affiliates permission to use my name or my dependent’s name, voice, statements, photographs and other reproductions and likenesses.  I understand that the above will be used in activities and publications of CSULB and the Asthma & Allergy Foundation of America, its constituents and affiliates and consent there to.

2.  WAIVER AND RELEASE OF LIABILITY FOR INJURY:

       In allowing (print child’s name) ___________________________ to participate in the Air Power Games^®, I understand and acknowledge that I assume all risk of any kind of injury that my child may receive or sustain as a result of participating in the Air Power Games^®.  Accordingly, by signing below, I understand that I hereby completely release the Asthma & Allergy Foundation of America – California Chapter; the State of California; the Trustees of the California State University; California State University, Long Beach: and California State University, Long Beach Foundation, and each of their agents, representatives and employees, from liability or responsibility for any and all claims, damages, injuries, losses or causes of action that may result from or arise out of my child’s participation in the Air Power Games^®

I consent to my child being photographed, videotaped or interviewed for the purpose of recording the Air Power Games^® experience and understand that this may be used for publicity, fundraising or other purposes.

      ____________________________________________________________________________

      Parent/guardian Signature                                                                  Date

      ____________________________________________________________________________

       *Child/dependent’s Name