Please Check Camp Session *

Volunteer First Name *

Volunteer Last Name *

Nick Name

Age *

Current Grade *

Participant's Mailing Address:

Volunteer Phone Number: *

Parent/Guardian Name: *

Parent/Guardian Phone Number: *

Alternative Contact (for emergency if you cannot be contacted): *

Alternative Contact Relationship: *

Alternative Contact Phone Number: *

Please describe any first aid training and/or special qualifications. *

Have you ever participated in a running sport before? *

Please describe any medical issues, allergies or special requirements: *

I understand that I am a volunteer for A Chance to Run, Inc. Summer Tune Up Camp under the direction of Paul Williams and/or Sheldon Cantrell. This is a non-paid position however I may elect to receive high school community service credit. I will report on time and maintain a professional appearance in uniform. I understand that I am to follow the directions of the adult camp sponsor; adhere to all camp rules and watch out for the safety of the participants to the best of my ability. Should I not be able to perform the above duties, I may be asked not to return nor receive any community service credit. *

Volunteer Signature: *

I give my permission for the above participant to volunteer and take part in A Chance to Run, Inc. Summer Track Camp. This volunteer/participant, to the best of my knowledge is in good physical condition and has no know conditions that may cause a health risk to themselves or another participant. I understand that Track, running and other outdoor activities have an inherent risk factor, and that all appropriate precautions will be taken for the participant. I give permission for A Chance to Run, Inc. and it's volunteers and/or hospital staff to administer proper medical assistance to the above named participant. I agree to release and hold harmless A Chance to Run, it's volunteers and benefactors from liability for all claims, resulting in any way from my participation in this Track Camp. I understand there is no affiliation with Sarasota County School System. *

Parent Guardian Signature: *