Flathead Lake Distance Running Camp

June 11-14, June 16-19, or June 20-23 2012

Camp Fee: $175 ($50 non-refundable deposit required). Make check/money order payable to: Flathead Lake Distance Running Camp. Deposit will guarantee position in camp on a first come first serve basis.

A late fee of $25.00 will be charged for entries received after June 10, 2012 for session one, June 15 for session two, and June 19 for session three. No refunds will be granted after June 4. Deposit required with application, balance due by June 11, 2012 unless other arrangements are made.

Student's Name__________________________Birthdate___________________________________

Gender (Please Circle) M  F 

Parent's Name(s)____________________________________________________________________

Name of School______________________________________________________________________ 

Home Address___________________________City_______________State_____Zip_____________

Home Phone (      )_____________Age_______HT________WT_______Grade (Fall 2011)______ 

T-shirt Size (Please Circle) S   M   L   XL

Session (Please Circle)

	Session 1: June 11-14, 2012

	Session 2: June 16-19, 2012

	Session 3: June 20-23, 2012

I understand that by the nature of the activity there is a possibility of accident, and assume the risk and responsibility while my son/daughter is attending the Flathead Lake Distance Running Camp. I, as parent/guardian of a minor student, permit emergency care to be administered to him/her as deemed necessary by the camp coach. I will allow the involved hospital and/or doctor to administer the required treatment of the emergency condition. I also understand that all incurred costs are my personal responsibility and that the Flathead Lake Distance Running Camp or its Directorship does not have insurance coverage for injuries to sport camp participants.


Parent or guardian's signature__________________________________

Campers are required to attend all camp sessions. Violation or abuse of camp rules may result in dismissal without refund. There will be absolutely no refunds of fee after June 4, 2012. Return application with payment to:

Flathead Lake Distance Running Camp
c/o Sara Brist
P.O. Box 8494
Kalispell, MT 59904-1494