Coach Morgan’s
“Great American Track Camp”
In collaboration with the City of Orange Division of Recreation
Location: Bell Stadium
(Bell Street between Main and Monroe St.) Orange, NJ 07050
Dates: Session I: July 30 - August 3, 2012
Session II: August 6 - 10, 2012 Time: 8:30am - 3:00pm

Camp Application
Name _____________________________________________________________________________________

Address ___________________________________________________________________________________

City/State/Zip ______________________________________________________________________________

Phone (Home) ______________________________________ (Cell) ___________________________________

Emergency Contact:

Name _____________________________________________ Phone _________________________________

Personal Data:

High School/middle School/Club Team _________________________________________________________

Coach ____________________________________ Best Events _____________________________________

Birth Date _____________________________ Age as of Aug. 2012 ________________ Sex _____________

Please check off the Session(s) you will be attending: ______ Session I ______ Session II
STATEMENT OF DISCLAIMER & CAMP APPLICATION
I AM AN ADULT OVER 18 YEARS OF AGE AND GRANT MY CHILD/CHILDREN PERMISSION TO PARTICIPATE IN THE TRACK & FIELD CAMP ACTIVITIES. I understand that all necessary precautions with be taken to protect each child from physical harm or property loss. The undersigned agree(s) that they do jointly and severally indemnify and hold harmless the City of Township and Orange Board of Education against liability for any and all claims for damages to property or injury to or death of my child or ward arising out of the scheduled activities. I also authorize Coach Morgan & the Great American Track Camp Staff, to act for me or my child according to their best judgment in an emergency requiring medical attention and hereby waive and release Coach Morgan & Staff, from ALL LIABILITY from all injuries while at the camp site. I have no knowledge of any physical impairment that would affect the camper listed above, in their participation in the camp. I have read and am voluntarily signing the authorization and release.

SIGNATURE_______________________________________________________ Date ____________________
(Parent or Guardian must sign)