(This form must accompany your entry cards)
School:         Class:     Boys Girls
Coach:         Wk.Ph.:       Hm Ph.:      
ENTER RELAY TEAMS BY PLACING A TIME ON A LINE.  List relay names on your entry card only.
  4 x 100 M Relay     4 x 400 M Relay   4 x 800 M Relay
ENTER INDIVIDUALS INTO INDIVIDUAL EVENTS.  An athlete may enter only four events.  You may enter an
athlete in more than one relay, but that person still may still only compete in four events, and they do count towards one of your
six relay names.
Name & Grade Event-Time/Dist. Event-T/D Event-T/D Event-T/D
We hereby certify these students are eligible to represent the _________________________ School District in accordance with our own
school districts, Section V, and NYSPHSAA eligibility standards and guidelines.
Coach's Signature Athletic Director's Signature Principal's Signature