Train Like a Champion...Learn Like a Champion...Play Like a Champion

Step 1...Registration
First name:
Last name:
Age:
Email address:
Confirm email:
Phone number:
Cell Phone number:
Mailing address:	T-Shirt Size
	Camper Cost Team Camper $385.00 (min. 5 members from the same team) Individual Camper $405.00 Commuter Camper $300.00
Step 2...Insurance Information
Name of Insured:
Insurance Company:
Policy Number:
Ins.Co. Address:
Ins.Co. Phone No.:
In consideration of the Tennessee Cross Country Camp granting my child permission to participate in the 2008 Tennessee Cross Country Camp, I hearby assume all the risks of his/her personal injury (including death) that may result from any camp activity. As guardian, I do hereby release the State of Tennesee, Tennessee Board or Regents, Austin Peay State University, Camp Cumberland, Tennessee Cross Country Camp and its director, officers, employees, agents, all instructors, and all participants in the camp from liability, including claims and suits at law or in equity, for injury, fatal, or otherwise which may result from my child taking part in the 2008 Tennessee Cross Country Camp activities. In addition, I hereby authorize and give my consent to the health authorities of Austin Peay State University or any licensed health professional to perform upon or administer any resonable, neccessary surgical or medical treatment. I also give permission to administer whatever anesthetic may be neccessary or advisable during the medical or surgical procedures. This authorization is intended to cover emergency treatment, immunizations, injections, and minor operations and procedures. In the case of psychiatric and/or psychological treatment, parent authorization for treatment beyond that responsive to the emnergency will be requested. I agree to assume all costs related to such treatment. I authorize my insurance company to pay benefits to Austin Peay Health Services or other hospitals and/or clinics. By clicking on the "I accept" button below. I am agreeing to all of the fore mentioned terms. I Accept I Decline
Step 3...Submit Information