APPLICATION
RESTON RUNNERS WOMEN'S TRAINING PROGRAM
May 5 - June 23, 2008 (8 sessions)
Mondays,  6:30-8:00PM
South Lakes High School track, Reston, VA

You may register for the 2008 Reston Runners Women's Training Program using a printed version of this form. On-line registration is also available. If you mail your registration, read the program waiver carefully. Fill out the 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. Bring this completed form and your $25 payment for each registered individual to the next session, or you may mail it to: Reston Runners (WTP), 12718 Longleaf Lane, Herndon, VA 20170

Program 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.

Name, Age (PLEASE PRINT):  ___________________________________    ____yrs

If under 18: Consenting Parent/Guardian Name (PLEASE PRINT):
__________________________________________

Consenting Parent/Guardian Signature / Date (MM/DD/YY):
________________________________  ___/___/___

Address:_____________________________________
___________________, _____ ___________

Phone number: (______) _______ -- ____________

e-mail address: ________________________________

Emergency Contact (name and phone): ____________________________ (____) ____-______

Signature & Date: _______________________________      __/__/____

Have you previously participated in WTP?   YES___ NO___

Please provide any important medical information we should know (allergies, drug reactions, etc) _________________________________________________
_________________________________________________
_________________________________________________

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