Welcome to the West Virginia Challenged Sports Championships May 2 5, 2012 On behalf of the West Virginia Wheelchair Track and Field Sports Inc., we are pleased to welcome you to the 18th Annual West Virginia Challenged Sports Championships, featuring one of the best field venues in the United States. This year s events include NRA Sanctioned Marksman Championships (Air Rifle and Pistol), Weightlifting, Archery, Swimming, and Track and Field. Good luck athletes! Jeremiah Gagnon Program Director
West Virginia Challenged Sports Championships Charleston, WV May 2 5, 2012 Registration instructions All athletes must be registered by April 14, 2012 or late fee will be applied. Fees: $45 and additional $10 if competing in Marksman Championship (air rifle/pistol). Make checks payable to WV W/C T&F Sports Inc. postmarked by 4/14/12. Late fee: $75 Entry fee includes: Awards, T-shirt, meals (Friday lunch, Saturday breakfast and lunch). If registered for Marksman Championship, there will be an additional/separate team award for this event; points will count toward overall team awards. Add an additional $5 per team member for team entries. Mail completed application and entry fee to: West Virginia W/C Track & Field Sports Inc. PO Box 1444 Charleston, WV 25325 Wheelchair and Ambulatory Sports USA All athletes must be a member of Wheelchair and Ambulatory Sports USA to compete in any of these events (for insurance purposes). NO EXCEPTIONS! Participants must sign up for WASUSA prior to competing this year. Questions can be directed to WASUSA at wasusa.org or call (732) 266-2634. Classification All first-year competitors should have a medical certification form completed by a physician. All medical forms should be on file with WASUSA. All competitors must have proof of classification and provide copy of classification card with registration or indicate on the registration form that classification is needed. Please mail information with your registration. All firsttime participants must be classified prior to competing. Transportation Competitors, coaches and visitors are responsible for their own transportation. Host Hotel: Marriott Charleston Town Center Room rate $84.00/night (includes parking) Call 800-228-9290 for reservations. Be sure to identify you are with this event to receive this rate. Please make reservation before April 16, 2012. For special requests, e-mail kathleen.ward@marriott.com. Schedule of Events: West Virginia Challenged Sports Championships All races W/C & Ambulatory (1,500; 5,000 meter; 10,000 meter Handcycle) May 2, 2012 1 to 2:30 p.m. Marksman Clinic & Registration Coonskin Lodge 3 p.m. First round of Marksman competition 6 p.m. Second round of Marksman competition May 3, 2012 8 a.m. Registration 9 a.m. Third round of Marksman competition 10 a.m. Registration for Archery competition 11 a.m. First round of Archery competition 2 p.m. Classification for Track & Field CAMC PT Gym Second round of Archery competition AWARDS CEREMONY (Marksman) ARCHERY AWARDS following event 1 May 4, 2012 7:30 a.m. Track & Field Registration Laidley Field 9 a.m. All field events and Pentathlon 9 a.m. 10,000 meter (separate heats Ambulatory, W/C, Handcycle) 2 p.m. Registration Swimming & Weightlifting venues TBA 3 p.m. First Swimming Heats 5 p.m. SWIMMING AWARDS UC Stadium May 5, 2012 8 a.m. Registration & 5,000 meter (separate heats Ambulatory, W/C, Handcycle) BREAKFAST Laidley Field / UC Stadium 8:45 a.m. Opening Ceremony 9 a.m. 60 meter (Jr only) 9:10 a.m. 5,000 meter, if needed 9:45 a.m. 800 meter 10:15 a.m. 100 meter 11 a.m. 400 meter 11:30 a.m. 200 meter Noon 100 meter Power Chair LUNCH 1 p.m. 1,500 meter (separate heats Ambulatory, W/C, Handcycle) 2 p.m. AWARDS CEREMONY
Track & Field Registration Registration Information Last name First name Age Address City State Zip Home phone Cell Phone E-mail address T-shirt size: S M Lg XL CAMC MEDICAL REHABILITATION CENTER CHALLENGED SPORTS PROGRAM WV TRACK & FIELD CHAMPIONSHIP Classification: Track Field Need classification: TRACK FIELD W/C Handcycle Ambulatory Powerchair (100m only) 60m Jr. only 1,500m Club (F1 only) 100m 5,000m Shot-put 200m 10,000m Discus 400m Pentathlon Javelin 800m Handcycle (1,500; 5,000; 10,000 only) Must be a member of WAUSA. 2
Swimming Registration Swimming Classification WV SWIMMING CHAMPIONSHIP Juniors (only) 25 Free 50 Free 100 Free 200 Free 500 Free 25 Back 50 Back 100 Back 25 Fly 50 Fly 100 Fly 25 Breast 50 Breast 100 Breast 75 IM 150 IM 200 IM Adults/Master 50 Free 100 Free 200 Free 500 Free 50 Back 100 Back 200 Back 50 Fly 100 Fly 200 Fly 50 Breast 100 Breast 200 Breast 150 IM 200 IM 400 IM 3
Marksman Registration WV MARKSMAN CHAMPIONSHIP Marksman Classification Circle one: SH1 SH2 Visual Impaired Pistol Rifle SIGN UP FOR: Clinic with USA Disabled Shooting Team Staff (included in fee) Check here if equipment is needed (specify): Rifle (60 shot) Pistol (60 shot) *if both, additional $5 fee. Check competition round you wish to shoot: Clinic May 2 1 to 2:30 p.m. (must be pre-registered) Rd 1- May 2 at 3 p.m. Rd 2-May 2 at 6 p.m. Rd 3-May 3 at 9 a.m. Team fee $32.50 (3 MEMBERS) TEAM NAME: TEAM MEMBERS: For more information contact Jeremiah Gagnon at (304) 388-7608 or jeremiah.gagnon@camc.org, or Roger Sack at (304) 906-5105 or airgunsnvwg@aol.com. 4
Archery Registration Archery Classification WV ARCHERY CHAMPIONSHIP Adapted Equipment or Open (please circle classification) MUST HAVE PERSONAL EQUIPMENT Juniors Novice Class (Men & Women) AR1 AR2 AR3 Cadet Class (Men & Women) AR1 AR2 AR3 Junior Class (Men & Women) AR1 AR2 AR3 Intermediate Class (Men & Women) AR1 AR2 AR3 Adults Standard Novice Class (Men & Women) AR1 (1A to 1C) AR2 (II to V) AR3 (standing) Short Metric Class (Men & Women) AR1 (1A to 1C) AR2 (II to V) AR3 (standing) Advanced Metric Class (Men & Women) AR1 (1A to 1C) AR2 (II to V) AR3 (standing) For more information call Deda Miller at (304) 549-2705. WAIVER AND RELEASE (all athletes must sign) I warrant that I am physically able to engage in the CAMC Medical Rehabilitation Center s Challenged Sports Program and I have no medical condition, which would prevent my full participation in this event. I knowingly, voluntarily and expressly waive, on behalf of me, my heirs and personal representatives, any claim that I or they may have against CAMC for injury or damages, including death, which I may sustain as a direct or indirect result of participating in this event. I forever release, waive, discharge and covenant not to sue CAMC, its trustees, officers, employees, agents and volunteers, for any injury or damages, including death, directly or indirectly resulting from my participation in this event. I have read the foregoing waiver and release of liability and fully understand its contents. Athlete s signature: Print name: Parent/legal guardian (under 18): Print name: *Events may be canceled if there are not enough registered participants. The CAMC Medical Rehabilitation Center, supported by the CAMC Foundation, sponsors statewide sporting competitions for athletes of all ages with physical disabilities through its challenged sports program, which is the only organized, sanctioned sporting program for the physically disabled in West Virginia. 23832-L11 5