Reston Runners: Interval Training Program Application

Every Wednesday, 6:30-8:00 PM, June 11 through August 27, 2008

Herndon Middle School

Please register for the 2008 Reston Runners' Interval Training Program (ITP) using a printed version of this form or, if you prefer, you may use our on-line registration.

If you mail your registration, read the program waiver carefully. Fill out this form and be sure to include your e-mail address, if you have one, as that will be one or our best means of keeping you informed of program updates. Sign the form. Your signature indicates your understanding of the program waiver. You may also register at the track, but ADVANCE REGISTRATION IS VERY HELPFUL. You must have a signed waiver on file before participating.

Make checks payable to RESTON RUNNERS. Mail this completed form and $25 for each registered individual to:

Reston Runners (ITP)
P.O. Box 2924
Reston, VA 20195

Waiver

I know that running and exercise are potentially hazardous activities. I should not enter and run unless I am medically able. I agree to abide by any decision of a program official relative to my ability to safely complete the program. I assume all risks associated with running and exercising in this program including, but not limited to: falls, contact with other participants, the effects of the weather, including high heat and/or humidity, traffic and the conditions of the road or track, all such risks being known and appreciated by me. Having read this waiver and knowing these facts and in consideration of your accepting my application, I, for myself and anyone entitled to act on my behalf, waive and release the Reston Runners Club, the Fairfax County School Board, Reston Association, the program directors and coaches, all sponsors, their representatives and successors from all claims or liabilities related in any manner to or arising in connection with my participation in this program even though that liability may arise out of negligence or carelessness on the part of the persons named in the waiver. I grant permission to all of the foregoing to use any photographs, motion pictures, recordings, or any other record of this running program for any legitimate purpose.

Participant:
Name (PLEASE PRINT): Last Name __________________; First Name _________________

Consenting Parent/Guardian Name if Registrant is under 18:
Name (PLEASE PRINT): Last Name __________________; First Name _________________

Address:_____________________________________

___________________, _____ ___________

Phone number: (______) _______ -- ____________

e-mail address: ________________________________

Participant Signature & Date (mm/dd/yy):

________________________________ ___/___/___

If under 18: Consenting Parent/Guardian Signature & Date

__________________________________________ ___/___/___

ENTRY NOT VALID WITHOUT SIGNATURE