Application-2019
Fairland Cross Country
Camp is open to all beginning
and experienced runners entering grades 6-12 in July, 2019. The cost is $90.
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 $90 check to: Fairland Athletic Boosters
Chuck Wentz
32 twp rd 1148
Proctorville, Ohio 45669
Make check payable to: Fairland Athletic Boosters.
Camper’s Name:
_____________________________
HS/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 2019) ______ 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:
_______________________________________