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Registration Type *--- Select Choice ---Please SelectAthleteCoach

Athlete Registration

Coach Registration

Name *

First

Last

Date of Birth *

Athlete - School Club Affiliation *

T Shirt Size *Please SelectSMLXL2XL3XL

Age *

Grade Level *

Gender *Please SelectFemaleMaleOther

EventAthlete's Event(s)Long JumpTriple JumpBoth Jumps

Parent/Guardian Information

Name *

First

Last

Address

Address Line 1

Address Line 2

City

--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Email *

Coach - School Club Affiliation *

Phone

Emergency Contact

• Same as Above

Name 2 *

First

Last

Email 2 *

Phone 2

Number of Campers

Registration Fee: $185.00

12345678910

Number of Coaches

Registration Fee: $90.00

12345678910

Confirmed Campers *

Service Fee: $6.02

12345678910

Registrations are subject to a $6.02 service fee per camper. Please reconfirm the number of campers you are registering.

Confirmed Coaches *

Service Fee: $3.18

12345678910

Coaches registrations are subject to a $3.18 service fee per coach. Please reconfirm the number of coaches you are registering.

Total Amount Due:

Order Summary

Item	Quantity Qty	Total
There are no products selected.
Number of Campers	1	$185.00
Number of Coaches	1	$90.00
Confirmed Campers	1	$6.02
Confirmed Coaches	1	$3.18
Subtotal
Total		$0.00

$0.00

Payment Method *Please SelectOnline - Credit Card/Debit Card

PayPal Commerce *

Card Number

Expiration Date

Security Code

Card Holder Name

Custom Captcha *

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