Camp Registration Form

SELECT CAMP DATE(S) FOR WHICH YOU ARE REGISTERING (CHECK ALL THAT APPLY): *
JUNE 10-12 (BOOKER HIGH SCHOOL)
PARTICIPANT FIRST NAME: *
PARTICIPANT LAST NAME: *
NICKNAME
AGE: *
GRADE COMPLETED: *
HAVE YOU RUN TRACK OR COMPETED IN A RUNNING SPORT BEFORE?: *
YesNo
ADDRESS: *
PARENT/GUARDIAN *
EMAIL ADDRESS *
CONTACT PHONE NUMBER *
ALTERNATIVE CONTACT *(For emergency in case you cannot be contacted)
RELATIONSHIP *
PHONE NUMBER *
PLEASE DESCRIBE ANY MEDICAL ISSUES OR SPECIAL REQUIREMENTS: *
(Use N/A if Not Applicable)
HOW DID YOU HEAR ABOUT THE CLINIC?: *
T-Shirt Size *
LIABILITY CLAUSE *
I give my permission for the above participant to take part in A Chance to Run Track & Field Clinic This participant, to the best of my knowledge is in good physical condition and has no known conditions that may cause a health risk to themselves or another participant. I understand that Track & Field and other outdoor activities have an inherent risk factor, and that all appropriate precautions will be taken for the partcipant. I give my permission to A Chance to Run and its volunteers and/or hospital staff to administer proper medical assistance to the the above named participant. I agree to release and hold harmelss A Chance to Run, its volunteers and benefactors from liability for all claims, including but not limited to, claims caused by or arising out of bodily injury or property damage resulting in any way from my participation in this Track & Field Clinic. I understand that there is no affliation with Sarasota County School System.I AGREE
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Please verify that all information on this form is correct before clicking the submit button below. Once you click submit, you will not be able to get back to this page. If you make a mistake and need help fixing it, please email Allison@AChancetoRun.com or call Allison at 941-961-5257. We will be glad to assist you!
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