Lynn Canal Running Camp
July 7-13, 2019 Juneau, AK
Camp Registration
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(Choose One)
Full Camp Registration ($350.00)
$175 Scholarship ($175.00)
$350 Scholarship ($0.00)
Camper Name
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Camper Email
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Camper Phone
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Camper Address
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State
Alabama
Alaska
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California
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District of Columbia
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Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
AA
AE
AP
Camper Gender
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Camper Date of Birth
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Month
January
February
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April
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December
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Camper Grade as of September 2019
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T-Shirt Size
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(Choose One)
Youth Small
Youth Medium
Youth Large
Women's Small
Women's Medium
Women's Large
Men's Small
Men's Medium
Men's Large
Men's X-Large
Men's XX-Large
Dietary Restrictions?
5k or 1 Mile PR
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School, Coach, Coach Contact Info
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This will be my ___ time at Lynn Canal Running Camp
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1st
2nd
3rd
4th
Parent Name
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Parent Email
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Parent Phone
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Participation Agreement and Media Waiver (sign with mouse below)
*
I understand that participation in the Lynn Canal Running Camp involves certain degrees of risk and can be physically, mentally, and emotionally demanding. I also understand that participation in these activities is entirely voluntary and requires participants to abide by applicable rules and standards of conduct.
In case of an emergency involving my child, I understand that every effort will be made to contact the individual listed as the emergency contact person. In the event that this person cannot be reached, permission is hereby given to the medical provider selected by the adult leader in charge to secure proper treatment, including hospitalization, anesthesia, surgery, or injections of medication for me or my child. Medical providers are authorized to disclose protected health information to the adult in charge, camp medical staff, camp management, and/or any physician or health care provider involved in providing medical care to the participant.
I have carefully considered the risk involved and give consent for my child to participate in these activities. I approve the sharing of the information on this from with Lynn Canal Running Camp volunteers and professionals who need to know of medical situations that might require special consideration for the safe conducting of Camp activities.
MEDIA/PHOTO WAIVER: I hereby authorize and give my full consent to Lynn Canal Running Camp to copyright and/or publish any and all photographs, videotapes and/or film in which I appear while attending this Camp. I further agree that Lynn Canal Running Camp may transfer, use or cause to be used, these photographs, videotapes, or films for any exhibitions, public displays, publications, commercials, art and advertising purposes, and television programs without limitations or reservations.
I, the undersigned, agree to the terms above.
Convenience Fee
$0.00
Running Total
$0.00
Coupon Code
Apply
Want to make LCRC affordable for everyone? Make a donation to our scholarship fund!
$
Total
$0.00
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