Free Summer Running & Fitness Camps for Native Youth

Camp Dates(Required)

Camp Location(Required)

Participant Information

Participant's Name(Required)

Grade (next school year)(Required)

Tribal affiliation(s) (if any)

Parent / Guardian Information

Parent's Name(Required)

Phone Number(Required)

If yes, please explain

If yes, please list medications

If yes, please estimate the number of miles (one-way)

If yes, please tell us which programs and around what year

If yes, please tell us their name(s), which program(s) and around what year(s) they participated (if you know)

Waiver

To be signed by a parent or legal guardian.

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. 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 with my signature below.

Parent / Guardian printed name(Required)

Emergency contact name(Required)

Emergency contact phone number(Required)

First Name(Required)

Summer Running & Fitness Camps

Running & Fitness Camp Registration Form

Camp Information

Participant Information

Parent / Guardian Information

Health & Medical

Wings History

Waiver

Emergency Contact

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