I hereby state that I am the coach of the below listed team, and that I have been authorized by the parent or legal guardian of the listed athlete(s) to enter them in the Topeka Super Indoor Invitational track meet. I further state that I have read the Participant Waiver, and understand its terms, and further understand that I am responsible for obtaining an executed written Participant Waiver from the parent or legal guardian of each of the athletes listed below before allowing the athlete to compete in the Topeka Super Indoor Invitational track meet. It is recommended that you retain a copy of the written Participant Waiver for your records. (additional form copies may be needed to complete roster)

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Team Name

_________________________                   ____________________________           ___________________________

Athletes name                                              Athlete name                                               Athlete name

_________________________                   ____________________________           ___________________________

Athletes name                                              Athlete name                                               Athlete name

_____________________________                           _____________________________

Coach’s name                                                        Coach’s Signature

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Date