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FOSS RUNNING CAMP
Services Branch Administrator
2018 FOSS RUNNING CAMP
($200 non-refundable fee must accompany this form)
Make check payable to: YMCA-Foss Running Camp
Balances are due by March 1, 2018 for week 1 and April 15, 2018 for week 2.
Week 1: August 12-18 | Week 2: Aug 19-25
Name: ____________________________________ Sex: M F DOB: ____-____-____
Your School: _______________________________ Coach's Name: _______________________________
Parent/Guardian: ____________________________ Home Phone: (____) ____-____ Cell Phone: (____) ____-____ Email Address: _________________________
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.
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 Lauren Frazier or e-mail at email@example.com