2009-2010 UNC Track & Field Open Training Camps

     Email Address:

     Parent/Guardian Name:

    Emergency Contact Name & Number:

    Telephone Number:

Weekly Clinics (Year Round)

  Monday & Wednesday 5:30-7:00pm   

   Date(s) planning to attend:                 

     (circle one day or both)  Monday

                                                   Wednesday

   Participant’s Grade:

     Participant’s Age:

     Participant skill Level (circle one):

                                               Elite

                                               Developmental

                                               Novice

     Sport(s)/Event(s)

___________________________________

*Every person attending The University of North Carolina clinic must have current health insurance coverage.

*Signature of parent or guardian below will serve as the medical release (if covered by parents insurance).

       Print Name of Parent/Guardian:  

       Insurance Carrier:

       Date:

       Policy #:

Checks and cash are the acceptable forms of payment that can be   brought to the clinic.

       Cost is $ 25.00 per session

       Make check payable to: “UNC Track Camps”

                  UNC Track & Field Camps

                  P.O. Chapel Hill, NC 27515          

 Please complete this form & return at the start of your first session.

Contact information for Camp Director:

Anthony Parker

(919)-673-4336  or unc.trackcamps@yahoo.com

NOTE:

*THE CLINICS ARE OPEN TO 9-18 YEAR OLD

MALE AND FEMALES

*THERE IS NO ATTENDANCE RESTRICTION BASED ON SKILL LEVEL