High School Camp Registration

Personal Information

Camper Full Name *

First

Last

Parent Name *

First

Last

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Camper Date of Birth *

Parent Email Address *

Camper Email Address *

Camper's School

Roommate Request

Gender *

Parent Phone Number *

Camper Phone Number *

Coach's Email *

Camper Home Address *

Address Line 1

Address Line 2

City

State

Zip Code

Emergency Contact

Full Name *

First

Last

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Relationship *

Phone *

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Training Information

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Estimated Average Summer Weekly Mileage *

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800m Personal Best

Time *

Type in your time without the colon, for example 2:20 would be 220

1600m Personal Best

Time *

Type in your time without the colon, for example 5:20 would be 520

3200m Personal Best

Time *

Type in your time without the colon, for example 10:20 would be 1020

5K Personal Best

Time *

Type in your time without the colon, for example 18:20 would be 1820

This will be my ___________ year at RunningWorks Camp *

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Parent Release & Insurance Information

I, the undersigned, individually or as parent(s) and guardian(s) of *

a minor, do hereby certify that he/she/them is in good physical condition to take part in RunningWorks, Inc.’s Cross Country Camp (herein known as “Camp”), and I do hereby request and authorize his/her participation in the Camp. I understand that cross country is an active, physical sport which involves physical hazards and that injuries can occur. Should a medical emergency arise and I cannot be reached, I hereby authorize the staff of the Camp to seek appropriate medical attention for him/her. I will be responsible for any and all costs of medical attention and treatment for him/her. I, the undersigned, my heir, executors and administrators, hereby agree to release, discharge and hold harmless RunningWorks, Inc., its officers, agent and employees of and from all causes, liabilities, damages, claims or demands whatsoever on account of any injury or accident involving the said minor arising out the minor’s attendance at RunningWorks, Inc.’s Cross Country Camp.

Parent/Guardian Signature *

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Parent/Guardian Name *

Policy Holder's Name *

First

Last

Insurance Company Address *

Address Line 1

Address Line 2

City

State

Zip Code

Parent/Guardian Phone *

Insurance Company Name *

Policy # *

Group # *

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Emergency Contact *

First

Last

Emergency Contact Phone

Physician Name *

First

Last

Physician Phone

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Camper Physical

Stamped/signed School or Physician’s CURRENT physical are required. Physicals MUST include record of allergies and immunization history. Please upload a copy of the physical below.

PLEASE NOTE: These documents can be submitted later on our website if you do not have access to the information at the time of registration.

Physical Documentation Upload

Click or drag files to this area to upload. You can upload up to 5 files.

Link to Physical Form (if you cannot obtain a copy of a school physical)

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Authorization for Administration of Medication Form

Link to Authorization Form

ONLY REQUIRED IF YOUR CHILD IS TAKING MEDICATIONS DURING CAMP. Parents must submit permission in writing, plus written orders from the physician, stating exactly how the medication should be taken. Once the form is filled out, please save and upload below.

PLEASE NOTE: These documents can be submitted later on our website if you do not have access to the information at the time of registration.

Authorization Form Upload

Click or drag a file to this area to upload.

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Camper Agreement Form

Parents/Guardians and Campers please read the following “Camp Policies” and indicate your acceptance by signing below.

RunningWorks Camp Policies

1. Campers are not permitted to possess and/or consume illegal drugs: First offense is immediate dismissal from camp.

2. Campers are not permitted to possess and/or consume alcoholic beverages of any type: First offense is immediate dismissal from camp.

3. Smoking is not permitted: First offense is dismissal from camp

4. All campers must abide by established curfews. First offense is dismissal from camp.

5. Male campers are not permitted in designated female living/sleeping areas. Female campers are not permitted in designated male living/sleeping areas. First offense is dismissal from camp.

6. All campers must stay within designated RunningWorks area. At no time shall a camper enter the woods or non-designated RunningWorks’ area without their running group and/or counselor. First offense is probationary action. Second offense is dismissal from camp.

7. All campers are required to abide by all camp-wide safety regulations and demonstrate an attitude of general cooperation. First offense is probationary action; second offense is dismissal from camp.

8. Willful damage to camp property and equipment is a serious offense. All campers are expected to treat all camp property with care and respect. First offense is probationary action and parents held responsible for the cost of the repair or replacement. Second offense is dismissal from camp.

9. Theft or conversion of the camp’s or other person’s property for their own use, however small, is a serious offense. First offense: probationary action and parents advised. Restitution is to be made.

10. No camper is permitted to possess or use fireworks or matches of any kind. First offense is dismissal from camp.

11. No camper is permitted to possess a knife of any kind or any other sharp or dangerous tool or weapon, real or fake. First offense is confiscation of item and probationary action.

12. Campers are not permitted to bring air conditioners, refrigerators, microwaves or televisions to camp. First offense is confiscation of item(s) for the duration of Camp.

13. Campers must attend all mandatory activities except when excused for reasons of health by the camp trainer or doctor’s note.

14. Campers are not permitted to leave Camp before the designated check out time without prior permission from the Camp Director AND permission from their parents. Furthermore, if a camper must leave prior to check out, the camper must be picked up by the parents or someone designated by the parents in writing. If a camper must leave early and drove to camp, they must submit a letter of permission to the Camp Director and signed by the parent before their departure.

15. Campers must stay in their assigned cabins. Switching of cabins or movement of beds/furniture is not permitted.

Consent *

We have read, understood, and agree to comply with the policies stated in: RunningWorks Camp Policies.

Parent/Guardian Name *

First

Last

Parent/Guardian Signature *

Date

Camper Name *

First

Last

Camper Signature *

Date

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Payment Information

Payments can be made by cash, check, money order, or PayPal. Your registration is not secured without payment.

Payments can be mailed to:

RUNNINGWORKS, INC.
P.O. Box 8832
Collingswood, NJ 08108

If paying via PayPal follow the link in your registration confirmation or on our website to pay.