CHAMPIONSHIP TRAINING ACADEMY
                                          A LONG GREEN LINE, INC. COMPANY


REGISTER NOW FOR CTA CO-ED RUNNING CAMP 2009!
June 18-July 31
Directed by Coach Charlie Kern

email info@championshiptrainingacademy.com for registration brochure
OR print this page with mail-in form

All participants receive expert instruction on
running form, strength, nutrition, and shoe selection.

Camp Schedule:
7:00-9:30 a.m. each Monday at Timothy Christian High School Track
8:00-10:30 a.m. each Tuesday-Friday at Wild Meadows Trace (Poplar and the Prairie Path)

________________________________________________________________MAIL-IN REGISTRATION FORM________________________________________________________________

Mail registration and check (payable to Long Green Line, Inc.) to: Championship Training Academy, 297 Oneida, Elmhurst, IL 60126
Cost: $200 ($6.25/day).

Name: __________________________________________________________________________________________________

Address: ______________________________________________City, Zip: _________________________________________

Phone:_______________________________________________ Email: ____________________________________________

Emergency Contact and Phone: ____________________________________________________________________________

Entering grade (6th-12th): ________________________________________

T-shirt size:     S     M    L      XL

WAIVER:
I, the undersigned participant, do hereby certify that I am aware and understand that participating in Championship Training Academy
is a strenuous physical activity, which is potentially hazardous. I am also aware and understand that I should not participate unless
I am medically capable of such strenuous physical activity, free from any physical impairment that would medically limit my ability
to safely engage in such an activity, and that I have properly prepared for such strenuous physical exertion and gradually trained over
an appropriate period of time. I assume all risks associated with running and walking in this camp, including  but not limited to:
injuries resulting from falls, missteps, dehydration, contact with other  participants, the effects of the weather including high
temperatures and/or humidity, and traffic and conditions of the road surface, grass surface, track surface, carelessness, horseplay,
my known and unknown medical conditions, and all other circumstances inherent to outdoor recreational activities,  all such risks
being known and accepted by me. Having read this waiver and knowing these facts  and in consideration of your acceptance of this
entry, I expressly and voluntarily assume the full  risk and legal liability and I hereby for myself, my heirs, executors, representative,
administrators and anyone entitled to act on my behalf, waive any and all claims I may have against, and release and discharge,
the Long Green Line, Inc., their officers, directors, volunteers and committee members, City of Elmhurst, USATF, Elmhurst Park District,
Timothy Christian High School and all sponsors and volunteers associated with the Championship Training Academy, their representative,
successors and assigns, for any and all injuries, damages, and losses, regardless of severity, suffered by me in connection with or relating
to the activities associated with participating in this club, including, but not limited to, activities held both before and after the activity.

Signature (Parent/Guardian if under 18) ______________________________________________________________________ Date ________________

CHAMPIONSHIP TRAINING ACADEMY | 297 Oneida, Elmhurst, IL, 60126
 630-306-2986 | info@championshiptrainingacademy.com