August 3-4, 2019

Atlantic City, NJ

The Biggest & Best Beach Vault In The

World Is Back For Our 11th Annual

Pole Vault Party On The Beach!

An Incredible Weekend Of Vaulting,

Music, Food, The Beach And The

Greatest Crowd At The Jersey Shore!

Mail Entry Form & Check Payable To:

Vertical Adventures

1 Sheffield Lane, Mt. Laurel, NJ 08054

Phone: (856) 231-0769 MPScooze@aol.com

www.VerticalAdventures.org

*PayPal Available On Our Website

Parental Consent/Participation Waiver: I hereby grant permission for my child to participate in the Vertical Adventures’ Jersey Jumps

Beach Vault, to be held August 3-4, 2019 in Atlantic City, NJ. I verify that my child has had a

physical exam in the past year and is able to participate in the activities related to the

Vertical Adventures Jersey Jumps Beach Vault. I agree to indemnify, hold harmless and defend

Michael J. Pascuzzo, Nickolas Tyson, Vertical Adventures Track & Field, AACSP LLC, City of

Atlantic City, All Vertical Adventures Jersey Jumps Beach Vault Coaches & Staff, All Beach

Vault Sponsors and/or their agents or employees from any and all liability for injury to my

child, as well as any injury or damage caused by my child. Should medical treatment for my

child be necessary, I hereby authorize any physician, trainer or EMT selected by Beach Vault

personnel to order and conduct medical or surgical procedures necessary. I also understand

that an additional Waiver & Release of Liability will be e-mailed to me upon registration. I

understand that my child is NOT permitted to participate in the Vertical Adventures Jersey

Jumps Beach Vault unless & until this additional Waiver & Release of Liability has been

completed, Signed & returned to the event organizers!

Parent/Guardian/Participant Signature:

___________________________________Date:_________

Jersey Jumps Beach Vault 2019 Sponsors Athletic Bio / Stats / Credentials

Titles Won (if any) ___________________

__________________________________

Best PV Memory/Moment As An Athlete:

__________________________________

For The BEST Track & Field Summer

Camps, Clinics, Meets, Events &

Our Year-Round “Vertical Club”

Pole Vault & High Jump Club

Visit

www.VerticalAdventures.org

**Beach Vault Hotel Discounts**

For Reservations, Call

1-888-516-2215

Caesars Atlantic City

Group Code: SC08JJ9

Bally’s Atlantic City

Group Code: SB08JJ9

*Room Rates Expire July 19, 2019

Jersey Jumps Beach Vault

2019 Daily Event Schedule

*2019 H.S. Graduates Compete in High School Divisions*

Saturday, August 3

10am Runway #1

-High School Boys/Girls-Novice A

(PR Under 10’0”)

Runway #2

-High School Boys/Girls-Novice B

(PR 10’0” & Up)

-Masters Men/Women (Age 40 & Up)

*Afternoon Competitions On Saturday Are Rolling Starts!

Competitors Should Arrive 2 Hours Prior To Their Event!

1pm approx. Runway #1

-High School Girls-Championship

(PR 10’6” & Up)

Runway #2

-High School Boys Championship

(PR 13’0” & Up)

Sunday, August 4

10am Runway #1

-Elite Women (PR 13”0 & Up)

-College/Open Women (Any PR)

Runway #2

-Elite Men (PR 16’0 & Up)

-College & Open Men (Any PR)

2019 Vertical Adventures

Jersey Jumps Beach Vault Entry Form

Name___________________________________

Age________ Gender (circle) Male Female

School/Club_____________________________

Address_________________________________

Town_____________ State____ Zip Code_____

Cell Phone # (_____)______________________

*Required: Allows Us To Contact You If Necessary!

E-Mail Address:

_______________________________________

E-Mail Mandatory, Please Print Legibly! This Is Our

Primary Method Of Contact With ALL Participants!

T-Shirt Size (circle) S M L XL

Personal Best _______Feet _______Inches

Division Entered (circle)

H.S. Boys/Girls-Novice “A” (PR Under 10’0”)

H.S. Boys/Girls-Novice “B” (PR 10’0” & Up)

H.S. Girls Championship H.S. Boys Championship

Elite Women Elite Men Masters M/W

College & Open Women College & Open Men

Registration Fee

____ $69 (If Received By July 15)

____ $89 (If Received July 16 thru July 25)

____ $99 (If Received July 26 thru August 1)

____ $119 (August 2 thru Day Of Event)

*Club Coach Discounts (SAME Envelope by 7/25)

5-9 Vaulters Only $60 each

10-15 Vaulters Only $55 each

16-19 Vaulters Only $50 each

20 or more Vaulters Only $45 each Over —->

Your Beach Vault Entry Includes:

-Pole Vault Competition -Jersey Jumps Beach Vault T-Shirt

-Vertical Adventures Discounts -Great Music & Swimming

-Loaner Poles Available, If Needed

Olympic Gold Medalist & World Record Holder, Jenn Suhr Set

The Jersey Jumps Record Of 15’1” Winning The 2015 Event!

Museum Quality Engraved Awards To

-H.S. Championship Winners (Boys & Girls)

-Elite Division Winners (Men & Women)

-College/Open Winners (Men & Women)

-Masters Men