Skyjumpers Connecticut
Summer Class Application
Mail to: Russ VerSteeg 3 Lathrop Lane Norwich, CT 06360
Individualized instruction
designed to provide an opportunity to pole vault in an atmosphere that
emphasizes safety, fun, socialization, and participation.
Name
_____________________________________
Address____________________________________
_____________________________________
______________________________________
Male
_____ Female _______ Age _______
e-mail
_________________________________________
Best
telephone number _________________________
School
______________________________
2010
USATF Membership Number ____________________________
Grade 2010-11 _________________________________
Best
Vaulting Height (Competition) _____________________
Sundays (1:00-2:30) ________
Sundays (2:30-4:00) ________
Sundays (4:00-5:30) ________
Wednesdays (3:30-5:00) ________
Wednesdays (5:00-6:30) ________ (College Group)
8
Classes: Cost $250. Please make separate checks: 1) $125 to Russ VerSteeg and
2) $125 to Thames Valley Gymnastics.
8 Sundays
June 27; July 4 (yes Independence Day), 18, 25; August 1, 8, 15, 22
8
Wednesdays
June 23, 30; July 7, 21, 28; August 4, 11, 18