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Edinboro Distance Village Mr. Douglas J. Watts, Jr. Head Track and Cross Country Coach Edinboro University of Pennsylvania Edinboro, PA 16444 |
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| Home Phone | Grade as of September 2005 | |
| Age | Sex: ____ M ____ F | Optional T-Shirt ($10 extra) S M L XL |
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Best Time/Performance __________ 400M __________ 800M __________ 1500M/Mile __________ 3200M - 5000M Years of Experience __________ |
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Check one: _____ Regular - $255 _____ Special Team Price - $240 _____ Paid in Full by 6/10/05 - $240 Minimum $25 deposit must be submitted. Remainder due at registration. Make checks payable to: Doug Watts |
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PARENT/GUARDIAN AUTHORIZATIONMy child has had a recent physical examination and is physically able to participate in all camp activities. I relieve the directors and Edinboro University of Pennsylvania of any responsibilities should any accident occur. I give consent for the Edinboro trainers and doctors to treat my child in case of injury or illness.
Parent/Guardian Signature: |
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