Youth Summer Camp - Lowell - Arkansas Track Club

Youth Summer Camp – Lowell

Please enable JavaScript in your browser to complete this form.

Parent's Name

First

Last

Parent's Email

Parent's Phone

Athlete's Name

First

Last

Athlete's Date of Birth

Athlete's Sex

Address

Address Line 1

Address Line 2

City

State

Zip Code

What is your shirt size?

Emergency Contact Name

First

Last

Emergency Contact Phone

Emergency Contact Email

Emergency Contact Relationship

Please list any medications you are currently taking along with dosage

Do you have any food allergies? If yes, please list below

Please list name and phone number of anyone allowed to pick up camper from camp.

Parent Signature

Clear Signature

Registration

Price: $125.00

Total

$0.00

Billing Information