Camper Info - Run Elite Program

Athlete Date of Birth(Required)

Athlete Age as of 7/7/2025(Required)

Home Phone(Required)

Emergency Contact Email(Required)

Emergency Contact Phone(Required)

Insurance Subscriber Date of Birth(Required)

Health Insurance Subscriber Relation to Camp Participant(Required)

Self, child, etc.

Health Insurance Subscriber Phone Number(Required)

Health Insurance Company(Required)

Health Insurance Phone Number(Required)

Health Insurance Policy Number(Required)

Health Insurance Group Number

Health Insurance Effective Date(Required)

Name of Participant’s Personal Physician

Physician’s Telephone Number

List any medications the participant will take while participating in this program:

Allergies to Medication:

List any physical conditions that may affect or limit full participation in any of the activities:

List medical devices the participant uses (if any)

Food Allergy/Special Diet If participant has a food allergy or has special dietary needs, please indicate those needs here.

Additional Medical Problems/Information (Asthma, heart murmur, rheumatic fever, etc.)

PDF in HTML

PDF in HTML

Parent or Participant Signature: I affirm that I have read, and agree to, the Participant and Parental Agreement found above.(Required)

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