General Information

Name Email

Phone Birthdate Male Female

Street Apt #

City State ZIP

Height Weight Do you have medical insurance? Yes No

What race will you be running on May 4, 2008?
5K
Half Marathon
Marathon

Have you ever ran this race distance before? Yes No

Running History

How many years have you been running?

How many miles per week do you currently run?

What is the distance of your long runs (in miles)?

Health History

Describe any injuries and when they last occured.

Do you have any health problems or family history of health problems which might affect or limit your training?

Are you currently using medication that may affect your training? Are you taking any supplements?

Goals

What is your goal time or finish for your race on May 4, 2007?

List any specific races and their dates that you want to compete in (or will be running in) between now and May 4, 2008 and indicate which ones are most important.

Any other comments or information you want us to know?

 

WAIVER OF LIABILITY; RELEASE; ASSUMPTION OF RISK; INDEMNITY
Carfully read the following and type your name ONLY if you agree to the terms.

In consideration of services provided by "Fast RunnerZ", I, for myself, my heirs, representatives, administrators, executors and assigns, knowingly and voluntarily, hereby: 1. TO THE FULLEST EXTENT ALLOWABLE UNDER LAW, WAIVE, RELEASE, FOREVER DISCHARGE, COVENANT NOT TO SUE, HOLD HARMLESS, AND AGREE TO INDEMNIFY FAST RUNNERZ, ITS OFFICERS, DIRECTORY, AGENTS, EMPLOYEES, AND/OR REPRESENTATIVES, AND/OR ALL OWNERS OF THE Facilities and/or the agents and employees of such owners (collectively, the "Related Parties"), FROM ANY AND ALL CLAIMS, losses, damages (including direct, indirect, actual and consequential damages ), demands, suits and/or other actions, including claims arising out of negligence (collectively, "Damages"), ARISING OUT OF OR IN ANY WAY RELATED TO MY USE OF ANY OTHER ACTIVITY CONDUCTED AND/OR MY PARTICIPATION IN ANY RUNNING RELATED ACTIVITIES /OR SUPERVISED BY ANY OF THE RELEASED PARTIES (the "Activities"). 2. Represent that I do not suffer from any physical ailments, limitations, disabilities or other conditions that might hinder my ability to participate in the above-listed activities without risk to my health. I HAVE READ THIS DOCUMENT AND FULLY UNDERSTAND ITS TERMS. BY SIGNING THIS DOCUMENT, I VOLUNTARILY ACCEPT ITS TERMS AND INTEND IT TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWABLE BY LAW. I AGREE TO INDEMNIFY FAST RUNNERZ AS PROVIDED HEREIN. FURTHER, I AGREE IF ANY PORTION OF THIS DOCUMENT IS HELD TO BE INVALID OR UNENFORCEABLE, THE REMAINDER SHALL NOT BE AFFECTED. IMPORTANT: Participants understand the inherent risk of rigorous running and should consult a physician prior to beginning. Participants assume all risk. A legal guardian must sign this waiver for children under the age of 18 years and bears full responsibility for the child's safety and welfare.

By typing your name, you are agreeing to and signing the above waiver.

Full Name *Required