Dennis McClanahan -- Mt. Carmel High School, 13014 Nightfall Terrace., San Diego, 92128

Make Checks Payable to: Mt. Carmel Athletic Foundation

Name ________________________________ Grade ______

Home Address _______________________ City __________

Zip Code _________ Phone # ( ) _____________________

School Name (Circle) Valley Center Cathedral Mt Carmel

Circle Male Female Experience Running _________________

T- Shirt Size ____________________

I, ___________________ (Parent/Guardian) verify that my child/athlete has received a physical examination in the past year and is physically capable to participate in the activities related to the Big Bear high Altitude Distance Camp. I am fully aware that running is a strenous activity and carries with it implied risk for injury. I hereby waive the camp instructors, Mt. Carmel High School, Valley Center High School, Cathedral High School, the Poway Unified School District and the Pauma Unified School District from any responsibility or liability of bodily injury to (runners name) ________________________ during the camp, and in going to or from the camp. I also authorize the camps assistants and representatives to secure medical assistance for my child/athlete as they deem necessary.

____________________________ ____________________

Parent or Guardian Signature Date :

In Case of Emergency Call: Name ___________________________

Phone # _________________________

Please read carefully and return completed. You will not be allowed to participate in any clinic activities unless this is filled out and returned.