Scarlet Knight Track & Field Day Camp LLC

Make Checks Payable to:

Scarlet Knight T&F Day Camp LLC

  Mail to:

                 Scarlet Knight T&F Day Camp LLC

                 c/o Sean Robinson

                 673 West Shore Trail

                 Sparta, NJ 07871

Includes a $50 Non-Refundable Adm. Fee

Session I 7/5 - 7/8       $80   _____  

Session II 7/12 - 7/15  $80   _____

Sessions I & II   

$140  _____

Each participant will receive a souvenir t-shirt:

Adult T-Shirt Size (Circle): 

S   M    L    XL    XXL  Men’s / Women’s

Name:__________________________________

Grade (Sept. 2009):______________________

Address:________________________________

________________________________________

Home Phone # :__________________________

Work/Cell # :____________________________

Email:___________________________________

Circle Events of Interest: 

Distance Running, Sprints, Hurdles, High Jump, Long Jump, Triple Jump, Shot, Discus, Javelin

 Name:_________________________

Family Physician and Phone #: _________________________________

Medical Insurance Company:

_________________________________

Policy#:_________________________

List any and all medications, allergies, or misc. physical disabilities which we should be aware of.

_________________________________

_________________________________

Emergency# _______________________________

I certify that the above named child is in good physical health, can participate in a rigorous group activity, and that I have medical insurance to cover any medical expenses incurred.  In case of medical emergency, the director of the camp has my permission to transport my child to the nearest hospital for care.  I realize that track & field is a physically demanding sport and injury is possible.

I release and discharge the camp sponsors, directors, and workers from all actions, suits, and demands whatsoever, in law or in equity, including but not limited to injuries or loss of personal property my child receives, directly or indirectly, while at camp.

Parent/Guardian Signature:

_______________________________________

Name of Parent/Guardian (Print):

 ________________________________________