CC RIDERS RUNNING CAMP OF EXCELLENCE

Name:

Week attending:  July 25 – Aug 2

Street:

City:

Zip:

Home Phone:	Email address:
Grade (Fall, 2008)    Sr.    Jr.    So.    Fr.  8th.  7th	School:

Emergency Contact:

Emergency Phone:

Age:

Gender:    M     F

Date of Birth:

T-shirt size:    S   M   L   XL

Do you have any special food needs or allergies?

I,_______________________________ (Parent/Guardian), hereby grant permission for my child, ________________, to attend the CC Riders Cross Country Camp and verify that my child has received a physical examination in the past year and is physically capable to participate in activities, some of which are physically vigorous, related to the camp. I understand that participation in a running camp, despite all reasonable precautions implemented for my child’s safety, caries a risk of injury.

Consequently, I hereby, for myself, my child, heirs, executives and administrators, do waive and release any and all rights against all persons given responsibility by the CC Riders Cross Country Camp for the conduct of activities and rendering of services to my child in association with our participation. I hereby authorize the staff of the CC Riders Cross Country Camp to act for me according to their best judgment in any emergency requiring medical attention and waive and release all involved from any and all liabilities for any injuries or illness incurred by my child during his/her involvement at this camp. I have no knowledge of any impairments that would limit or preclude my child’s involvement in any activities commonly associated with this type of instructional camp. I agree that costs for treatment of injuries or hospitalization for illness or injuries incurred during the camp will be the responsibility of the parent or guardian of the camp participant. I agree that any insurance carried by the parent or guardian may be used to defray such medical and hospital costs.

Parent/Guardian signature:                                                                                   Date:

Code of Conduct

At a minimum, each participant is expected to:

· Be responsible for his/her own belongings.

· Follow all camp regulations.

· Be attentive and responsive to the supervisory instruction provided to insure you have a safe and fun camp experience.

· Create a cross country digital portfolio page for later presentation to the Runners Parent Group.

I hereby acknowledge that I will observe all camp rules as listed and told to me and accept that in case of noncompliance, I will be subject to immediate dismissal. I agree to provide for my own transportation arrangements should I be dismissed from the camp. I further recognize that my parents/guardians or myself will be held financially and legally responsible for any damage caused by me to the camp and/or its property or facilities.

Camper’s signature: