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FOSS RUNNING CAMP
Deborah
J. Farmer
2008 FOSS RUNNING CAMP
Registration
($100 non-refundable fee must accompany this form)
Make check payable to: YMCA-Foss Running Camp
Balances are due by July 1, 2008
August 10-16 August 17-23
Name: ____________________________________ Sex: M F DOB: ____-____-____
Your School: _______________________________ Coach's Name: _______________________________
Parent/Guardian: ____________________________ Phone # (home): (____) ____-____ (work) (____) ____-____
Address: ___________________________________ City: ___________________ State: ____ Zip: ________
Emergency contact person: ___________________________ Phone #: (____) ____-____
In consideration of this application being accepted by FOSS RUNNING CAMP, I hereby for myself, my heirs, executors, administrators and assigns, waive and release forever any and all rights or claims whatsoever that I may have against FOSS RUNNING CAMP, its Director, Administrators, or any staff appointed by them for any injury/illness that may be suffered by me arising out of or in any way connected with my attendance at FOSS RUNNING CAMP.
FOSS RUNNING CAMP has my permission to administer care in the event of injury or illness.
I certify that I am physically fit, have had a physical examination and have trained for my participation at FOSS RUNNING CAMP.
Date: ____-____-____
Runner's Signature: _________________________
Parent/Guardian Signature (if under 18): __________________________
EMAIL ADDRESS[PRINT-Case Sensitive] ___________________________________________________________
If you do not hear back from us in 4 weeks call Deb Farmer or e-mail her at dfarmer@qmfymca.org