We’ve Got The Olympians At The 2012 “On The Road” Track & Field World Tour A Unique Camp Experience / 20th Anniversary Medford, NJ (Lenape H.S.)…..July 14 & 15

The ONLY Camp In The World Staffed Exclusively With Olympians Of The Past, Present & Future!

High Jump With Long Jump & Triple Jump With 100/110/400 Hurdles With Hollis Conway Norm Tate & Andre Phillips &

Hollis Conway Norm Tate Carol Lewis Andre Phillips Olympic Silver Medalist USA Olympic Team Member (TJ) 3-Time USA Olympic Team Member (LJ) Olympic Gold Medalist (400 IM) Olympic Bronze Medalist Former American Record Holder 2-Time American Record Holder #1 Ranked Hurdler In World History World Championships Gold Medalist 3-Time USA National Champion (TJ) 4-Time USA National Champion Personal Bests Of 47.19 (400 IM), 13.25 (110 HH), 44.71 (400 M) Goodwill Games Gold Medalist Personal Bests Of 55’11 1/2” 2-Time NCAA Champion (Houston) 2-Time #1 Ranked In The World 27’ 1 1/4” (LJ) Personal Best Of 23’1 1/4” Roger Kingdom 3-Time American Record Holder 2-Time Olympic Gold Medalist (110H) 10-Time USA National Champion Former World Record Holder 3-Time NCAA Champion (SW Louisiana) & Discus With World Championships Gold Medalist 2-Time NCAA Record Holder Personal Best of 12.92 (110 HH) Personal Best Of 7’10 1/2” Augie Wolf & Knut Hjeltnes Benn Fields Sprints/Relays With USA Olympic Team Member 3-Time All-American (Seton Hall) Augie Wolf Knut Hjeltnes Thomas Jefferson Personal Best Of 7’6 1/2” USA Olympic Team Member (SP) 4-Time Olympic Team Member USA World Championships Team 4-Time All-American (Penn State) Pole Vault With PR’s: 71’3 1/2” (SP), 210’6” (Discus) PR’s: 228’5” (Discus), 67’5” (Shot Put) Olympic Bronze Medalist (200m) 12-Time USA National Team Member Lawrence Johnson Personal Bests Of 10.08 (100m). 20.21 (200m), 45.40 (400m) Javelin With Middle Distance /Distance Olympic Silver Medalist (2-Time USA Olympian) Brian Chaput With Ringo Adamson Decathlon/Heptathlon World Championships Gold Medalist Former American Record Holder (Indoor & Out.) With Rob Muzzio 7-time USA National Champion 2-Time USA Olympic Team Alternate 2-Time Olympic Team Member (Jamaica) 4-Time NCAA National Champion NCAA Champion 6-Time World Cross-Country Team 6-time All-American (Tennessee) 3-Time All-American (Penn) NCAA Track & Field Hall Of Fame USA Olympic Team Member Personal Best Of 19’7 3/4” Personal Best Of 263’11” NCAA National Champion (Steeple) 3-Time World Championships Team (1st Decathlete in History) Addtl. Staff: Mike Vukovich (HJ)/Brenner Abbott (PV)/Frank Harrison (Throws)/John Taylor (Javelin)/Tony Darden (Sprints)/Brian Wethey (Throws) 2012 Camp Entry Form ONLY $50 due at time of registration, then 3 Easy Payments. Attn: Register prior to February 21 & receive a $10 discount on $199 tuition ONLY!

Name______Age______Grade Fall 2012______School______

Address______Town & State______Phone(______)______

Zip Code______Male____Female____ E-mail (Mandatory, Print)______

T-Shirt Size (Circle) S M L XL XXL *We Provide FREE Airport Pick-Up & Drop-off @ Philadelphia International Airport

Camp Plan Selected: _____$199 Commuter _____$299 Resident (1 Night Hotel) _____$349 Resident (2 Nights Hotel)

_____$99 Coach (Resident Coaches Add $70 / Night to Share a Room, $120 / Night for a Single Room, please specify on entry) *Coach FREE With 3 PAID Campers! (ALL 3 Camper Entries PLUS Coaches Entry MUST Arrive In Same Envelope)

Roommate(s) Preference:______*To Guarantee Roommate, Register Together Or Confirm Roommate By 6/30/12. Rooms are Double Occupancy unless a Single Room Payment is made.

Event(s) (Campers May Participate in 1 Or 2 Events ONLY!): High Jump____ Pole Vault____ Long Jump____ Triple Jump____ Hurdles____

Sprints/Relays____ Shot Put____ Discus____ Javelin____ Middle Distance/Distance____ Decathlon/Heptathlon____

Parental Consent/Participation Waiver: I hereby grant permission for my child to attend the “On The Road” Track & Field World Tour Summer Camp. I verify that my child has had a physical exam in the past year and is able to participate in the activities related to the camp. I agree to indemnify, hold harmless and defend Mike Pascuzzo, Vertical Adventures, Lenape Regional High School District, First Student Bus Company, Courtyard by Marriott, All Camp Clinicians & Staff, All Camp Sponsors and/or their agents or employees from any and all liability for injury to my child, as well as any injury or damage caused by my child. Should medical treatment for my child be necessary, I hereby authorize any physician or trainer selected by camp personnel to order and conduct medical or surgical procedures necessary.

Parent or Guardian Signature:______Date:______Send Entry Form And Deposit Payable To: For Additional Information: Michael Pascuzzo Phone: (856) 231-0769 / Fax: (856) 722-1789 1 Sheffield Lane, Mount Laurel, NJ 08054 [email protected] Register Early, Space Is Limited! www.VerticalAdventures.org