First Name:      Last Name: 

Address:    City:   State: 

Zip:   Email:   Phone No. 

Sex:  ? Female Male   Year in school (upcoming year):  Freshman Sophomore Junior Big Bad Senior  

 Which camp will you attend? Week One: Dublin Week Two: Westerville

High School:       High School XC Coach:    

Parent(s) Name:       Parent(s) Phone Number:   

Emergency Contact(s) Name:    Emergency Contact(s) Phone: 

Allergies, Medications, Special Instructions:

EXTRA: Every camper receives Mizuno running shorts and Running Times subscription. You may also buy a t-shirt for an additional $10.
Would you like to buy a t-shirt?  ? Yes, get me a sweet shirt No, no shirt for me.

If yes, what size? Small Medium Large X-Large

Waiver:   In consideration of the acceptance of this entry, I hereby waive and release any and all rights and claims for damages that I or my heirs may have against the Columbus Running Company, the Camp directors, event sponsors and volunteers. I certify that the entrant is medical able and willing to participate in the camp.              

By selected "I Agree" below, you are authorizing your signature to be taken electronically, which holds the same value as your written signature.
Waiver Signature:                            I Disagree I AGREE