2019 High Peaks Camp 3 Registration
#1 *
I understand this registration is for the July 2019 Camp 3 only.
#2 *
I understand that payment must be submitted online through PayPal immediately or by mailing check to Camp Director by next business day. PayPal Credit offers "no interest" financing, if desired. I have read the camp Refund Policy and acknowledge the $100 non-refundable camp processing fee.
Payment *
Please indicate your method of payment.
Payor *
For reference, please provide the full name of the person (on charge card or check) responsible for payment of registration fee.
Your answer
Camper Athlete Information
First Name *
Your answer
Last Name *
Your answer
Athlete Email *
Your answer
Parent/Guardian Email *
Your answer
2nd Parent/Guardian Email
Optional second email address
Your answer
Telephone *
Please enter format of: xxx-xxx-xxxx
Your answer
Street Address *
Your answer
City *
Your answer
State *
Please enter 2 digit U.S. state postal abbreviation, e.g., NY - or the province/region outside of U.S.
Your answer
ZIP *
U.S. Postal Zip Code. Enter 0 or other for international addresses.
Your answer
Country *
Your answer
SSN-4 *
Enter last four digits only of Social Security number. It must be accurate and your own (camper/athlete) as required by the USOTC. If you are not a U.S. citizen, enter a zero in this field.
Your answer
Gender *
Grade *
Current school grade during the spring camp you attend, or your rising grade during July camps (the grade level attending next fall).
Birth date *
Please replace current year with BIRTH year.
MM
/
DD
/
YYYY
T-Shirt Size *
T-shirts are all adult sizes.
School *
Name of school currently attending
Your answer
Coach *
Name of running coach
Your answer
Achievement 1
List any running achievement gained
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Achievement 2
Running achievement
Your answer
Achievement 3
Running achievement
Your answer
Goal 1
List running goal
Your answer
Goal 2
List running goal
Your answer
Goal 3
List running goal
Your answer
Confirm *
I understand the registration process is not complete until I submit the Survey and make payment. Press the Submit button below to finish this registration form.
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