2023 Whiteriver, AZ Running & Fitness Camp Registration
From 9:00am to 3:00pm, June 22nd and 23rd (Thurs./Fri.) at Theodore Roosevelt School. 805 Apache Street, Fort Apache, AZ 85926. Camp hosted in partnership with White Mountain Apache Tribe Diabetes & Wellness Program. Please complete a registration form for each participant. Day-of registration and "open gym" will be available from 8am-9am. Camp activities from 9am-3pm each day. Lunches and water will be provided. Please bring your own water bottles, hats and sunscreen. Comfortable clothing and athletic shoes are strongly recommended.
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Participant First Name *
Participant Last Name *
Age *
Grade (Next School Year) *
Gender *
Tribal Affiliation(s) *if any
Parent Name *
Parent Phone Number *
Parent Email Address
Family Mailing Address *
Emergency Contact (if different from parent phone #)
Relation of emergency contact to participant
Has your child participated in a Wings Running and Fitness Camp before? *
If "yes" please estimate the number of times/years:
Will your child participate with another family member? *
Will you travel more than 20 miles (one-way) to bring your child(ren) to camp? *
If "yes" please estimate the number of miles (one way):
Does your child participate in an after-school sport during the school year? *
If "yes" which sport(s)
How important is it to you that your child is exposed to the following? *
Not important
Somewhat important
Important
Very Important
Exercise routines/methods that encourage regular physical activity.
Diet and nutrition lessons that encourage healthy eating habits.
Native American running history.
Native American heroes and role models.
Competitive sports.
Activities that promote mental health.
Their Native language.
Lessons about the effects of diabetes on the human body.
New places. (travel)
Information about how to go to college.
Being on a team.
Sports injury prevention techniques.
Teachings that promote spiritual health/wellness.
Have you (parent/guardian) ever participated in Wings programs? *
If yes, please tell us which programs and around what year(s):
Waiver: I hereby release The Earth Circle Foundation, Inc. (dba Wings of America) and all agencies and/or sponsors whose property and/or personnel are used from responsibility for any injuries and/or damages my child may suffer as a result of their participation in "Running & Fitness Camp". I hereby certify that my child is in good physical condition and is safely able to participate in this fitness-centered event while wearing a mask. Additionally, I permit the use of the name, voice and/or likeness of my child in broadcasts, telecasts, newspapers, brochures, etc. produced by and/or in cooperation with Wings of America and/or Running & Fitness Camp sponsors/collaborators. As the parent and/or guardian of the above named child, I certify that all the information in this form is true and complete. I have read the information provided and certify my compliance by selecting "I agree" below. Should I select "I disagree", I understand that I will be contacted by a Wings representative to see if any of the above conditions may be adjusted so that I feel comfortable with my child participating. *
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