Poconos High School Registration Form 2019
Camper Info
Camper's First Name *
Your answer
Camper's Last Name *
Your answer
Camper's E-mail *
Your answer
Gender *
Address
Street *
Your answer
City *
Your answer
State *
Zip Code *
Your answer
Parent/Guardian Name *
Your answer
Parent/Guardian E-mail *
Your answer
Home Phone # *
Your answer
Parent Cell Phone # *
Your answer
Parent Work Phone # *
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Phone # *
Your answer
School Info
Coach Name
Your answer
Coach E-mail
Your answer
Grade Entering *
School *
Your answer
Training Info
Estimated Average Summer Weekly Mileage *
Personal Best 800m (Enter 00:00 if event not run) *
Hrs
:
Min
:
Sec
Personal Best 1600m (Enter 00:00 if event not run) *
Hrs
:
Min
:
Sec
Personal Best 3200m (Enter 00:00 if event not run) *
Hrs
:
Min
:
Sec
Personal Best 5k (Enter 00:00 if event not run) *
Hrs
:
Min
:
Sec
Roommate Request (We will do our best to accommodate your request)
Your answer
This will be my *
How did you learn about us? *
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