Application-2016

Fairland Cross Country Camp is open to all beginning and experienced runners entering grades 6-12 in July, 2015.  The cost is $85.    Payment for camp is due by July 1st along with the medical release form.  Space is limited so register early. 

Send completed application along with the $85 check to: Fairland Athletic Boosters

Chuck Wentz     32 twp rd 1148 Proctorville, Ohio 45669

Make check payable to:  Fairland Athletic Boosters.

Camper’s Name: _____________________________ High School/MS:__________________

Address: ______________________________________________

City: ________________________ State: _____  Zip Code: _______

Name of parent/guardian: _________________________________

Home telephone: _________________ Parent’s work phone: __________________

Camper’s email address: ___________________________________

Parent’s email address: ____________________________________

Date of birth: ___________  School grade (fall 2016) ______  Circle:     Male       Female

Best times: 800 ______ 1600 ______ 3200 _______    XC 5k _________

Course best XC time was run on: ____________________________________

T-shirt size: (circle one)                Small               Medium                 Large

Parent signature: _______________________________________