CAPON RIDGE RUNNING CAMP
Address______________________
City:_____________State:___Zip:_____
Phone:_______________________
E-mail address:_________________
Parent Name:__________________
Parent email:__________________
High School___________________
Grade(Fall �04)________________
Gender: Male Female
T-Shirt Size: XS S M L XL
Return Registration form to:
Capon Ridge Running Camp
c/o Metro Run & Walk
P.O. Box 3090
Falls Church, VA 22043
All information is required in order to process this application
You must send proof of medical insurance with application (A photocopy of the front and back of the campers medical insurance card is required)
Please do not bring valuables, electronics or large sums of money. The camp will not be responsible for lost or stolen items
Waiver/Medical Consent:
I hereby state that my child is in good normal health, and has my permission to participate in all camp activities. In the event of injury or illness, I authorize the staff of Capon Ridge Running Camp to act for me in securing medical treatment. Registration in Capon Ridge Running Camp requires that a parent/guardian sign below to agree that in case of accident or injury while attending camp, they release the camp, the coaches, counselors, and any associated parties from any and all liability. Further, I grant permission to all the foregoing to use any photographs, motion pictures, recordings, or any other record of this event for legitimate purposes
Each participant is required to carry personal medical coverage
_____________________________
Signature of Parent
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Date
