Eastern Youth Summer Running Camp
Please complete the form below to sign up for the Eastern Youth Summer Running Camp.

Additional information including a printable registration form is available on

Please direct any questions about camp to Camp Director & Eastern Head Coach, Mike Horan, at michael.horan@jefferson.kyschools.us.

If registering multiple campers please complete the form multiple times.
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Last Name *
First Name *
Grade Entering for 23-24 school year *
Gender *
School Name
Street Address
City
State
Zip
Phone Number *
Additional Phone Number (optional)
Email Address *
Additional Email Address(es) (optional)
T-Shirt Size *
Running Experience
Clear selection
If experienced, how many years running?
If experienced, longest run this year?
For experienced Middle School Runners only: Do parents grant permission to run off campus under the supervision of a HS partner runner? *
Waiver of Liability
Waiver of Liability and Statement of Fitness:
In consideration of acceptance of this entry and permission to participate in the Eastern High School Cross Country Camp
both participating runners and families hereby waive and give up myself, my heirs, my family members, and all claims
against Eastern High School Cross Country Camp staff members, counselors, sponsors, and against any person associated with the Eastern High School Cross Country Camp in the case of injury which may directly or indirectly result from my participation at the Eastern High School Cross Country Camp. I also give my permission to the Eastern High School Cross Country Camp Staff to use any photography, video, or other recordings of me that are made during the course of the camp for news media purposes.
By signing up to attend camp, I agree to the above stated waiver of liability *
Required
Camp Rules and Medical Consent Form
Rules for Camp
• Students are to be respectful to camp staff.
• Students are to listen and learn during teaching sessions.
• Students are to show respect to all other campers at the camp.
• Students are to keep their trash and personal items picked up during and after training sessions.

Any student that breaks these rules will be sent home immediately without a refund. The Eastern Cross Country Program is a program that demands discipline and excellence from its runners. If you agree to the above rules, note below.

Medical Consent Form
Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examinations and immunizations for the above named student. In the event of serious illness, the need for major surgery, or significant accidental injury, I understand that an attempt will be made by the attending physician to contact me in the most expeditious way possible. If said physician is not able to communicate with me, the treatment necessary for the best interest of the above named student may be given.
In the event that an emergency arises during a practice session, an effort will be made to contact the parents or guardians as soon as possible. Permission is also granted to the athletic coach to provide the needed emergency treatment to the athlete prior to his or her admission to the medical facilities.
By signing up to attend camp, I agree to the above stated rules and medical consent. *
Required
Please include any additional helpful contact information below.
Please include any additional important information about your camper below.
Questions & Payment Options
Please direct any questions about camp to Camp Director & Eastern Head Coach, Mike Horan, at michael.horan@jefferson.kyschools.us.

After completing this online registration please make payment for camp by mailing a check (with registered athlete names in the memo line) or make online payment via PayPal using https://www.paypal.com/paypalme/eastern400mproject (please include the camper names in the "note" section on PayPal).

Check payable to Eastern XC Boosters
Mail to:
Mike Horan
12403 Barbizon Court
Goshen, KY 40026

If registering after July 8th please pay online or bring payment to camp on July 11th.
Form of payment *
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