2015 BOILER TRACK & FIELD
AND CROSS COUNTRY CAMP, LLC
REGISTRATION FORM
All information on this form MUST be completed in order to guarantee a
place in the camp.
FOR FASTER REGISTRATION BEFORE SPOTS FILL UP,
REGISTER ONLINE AT
Full Name: ________________________________________________
Address: __________________________________________________
City: _____________________________________________________
State: _______________ Zip:________________________________
Home Phone: (
) ________________________________________
School: ___________________________________________________
Grade (Fall 2015): _______________ Age: _______________________
Gender:
Male
Female
_________________________________________________________
Printed Name of Parent/Legal Guardian (required)
_________________________________________________________
Parent/Legal Guardian E-mail Address (required)
Roommate Name: __________________________________________
Must be mutual. Applications must be returned together. Double occupancy only.
EVENT INTEREST AREA
(Please circle one or more):
SPRINTS *HURDLES*POLE VAULT *HIGH JUMP *LONG
JUMP*TRIPLE JUMP *SHOT PUT *DISCUS*CROSS
COUNTRY/DISTANCE
Adult T-shirt Size:
S
M
L
XL
XXL
XXXL
If you require an accommodation or special assistance for this camp due to a
disability, please contact us at greenel@purdue.edu.
FOR MORE INFORMATION
FEE
For more information on registration and camp content, contact:
RESIDENTIAL $475
COMMUTER $450
TEAM $450
LATAYNA GREENE
Total Amount Enclosed: ______________________________________
Phone: 765.496.7893
Make check or money order payable to:
E-mail: greenel@purdue.edu
or
BOILER TRACK & FIELD AND CROSS COUNTRY CAMP.
confreg@purdue.edu
1-866-515-0023
RETURN THIS FORM WITH PAYMENT TO:
PURDUE UNIVERSITY
BOILER TRACK & FIELD AND CROSS COUNTRY CAMP, LLC
128 Memorial Mall, Stewart Center, Room 116
or
WEST LAFAYETTE, IN 47907
REGISTRATION DEADLINE IS JUNE 15, 2015