Rosebud Rez Runners Membership Form

Contact Information:

Name:______________________________

Phone:______________________________

Address:___________________________

E-mail:_____________________________

Other Information:

# of days running or walking/week:__________

Goal # of days running or walking/week:__________

# of miles running or walking/week:_________

Goal # of miles running or walking/week:__________

Goal races and/or times: (Ex. Finish a 5k or Complete a Half marathon in 2 hours):

THE WAIVER MUST BE READ AND SIGNED BEFORE PARTICIPATION.

I know that running and volunteering to work in club races and other club events are potentially hazardous activities and that I should not enter or participate in such activities unless I am medically able and properly trained. I agree to abide by any decision of a race official relative to my ability to safely complete a run. I assume all risks associated with running and volunteering to work at club races and activities including, but not limited to falls, contact with other participants, the effects of the weather, including high heat or humidity, the conditions of the road and traffic on the course, all such risks being known and appreciated by me. Having read this waiver and knowing these facts and in consideration your acceptance of my application for membership, I for myself and anyone entitled to act on my behalf, waive and release the Rosebud Rez Runners, and all sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation in these club activities even though that liability may arise out of negligence or carelessness on the part of the persons named in this waiver. Further, I hereby grant full permission to any of the foregoing to use any photographs, videotapes, and any other record of club events for any legitimate purposes.

I have read and understand this waiver: _________________Date:__________

Parent/Guardian if member is a minor:__________________Date:_________