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2019-2020 Running Club Permission Form
Binford Badger Running Club

Binford Elementary invites students in grades 5-6 to participate in a free, after school running club. The program will include warm ups, stretches, group runs, games, and a healthy snack (provided on Thursdays). Students will meet in the gymnasium after school. Students must change clothes/shoes before, if needed.

At least two adult sponsors will be present to help supervise and lead the activities.

Registration is required as limited space is available. Please fill out the form. You must have a form filled out to participate. If you have any questions please email Mr. Shepherd at bshepher@mccsc.edu.
Deadline to register is Tuesday, February 18th.

WHO IS ELIGIBLE?
• Students in Grades 5th or 6th

PICK UP
Students must be picked up by 5:00pm. Please be on time.
• Pick up will take place outside the gym doors.
• If you are unable to pick up your child on time, please consider registering your child for extended day ahead of time. Website: http://www.mccsc.edu/Page/356 Phone number: (812) 330-7702.

DATES
Running club will start on Tuesday February 18th, and the last practice will be on Thursday April 16th. The optional 5K is Saturday April 18th. (Running club practices are every Tuesday and Thursday).

ADDITIONAL INFORMATION
• What to bring: water bottle, running shoes, and appropriate athletic clothing
• If weather prevents the group from going outside, programming will be inside (gym, cafeteria, classrooms, hallways)
If participant uses an inhaler or epi-pen, consider sending one with them to have on hand (as access to the school health office will not be available after school hours).
• Participants will keep their belongings in the gym or cafeteria.
• Questions? Contact Brian Shepherd bshepher@mccsc.edu

WAIVER AND RELEASE


Email address *
PARTICIPANT Name (First and Last) *
Your answer
PARTICIPANT #2 (If Applicable)
Your answer
PARENT/GUARDIAN Name *
Your answer
PARENT/GUARDIAN Phone Number *
Your answer
Emergency Contact Name and Phone Number *
Your answer
Please list any allergies and relevant medical information. (If none, please indicate "none"): *
Your answer
Please list any additional information that we should be aware of to help better serve your child:
Your answer
Pick-Up Information (Select all that apply) *
Required
If your child has permission to go home with another adult, please specify:
Your answer
Please read and agree to the following waiver and release. *
Captionless Image
Required
Please read and agree to the medical treatment policy. *
Captionless Image
Required
Please read the MCCSC video release policy. *
Captionless Image
Participant, please read the following, "I understand that this is a voluntary program and there is no fee for participation. I further understand that my child(ren) may be dismissed from the program for inappropriate behavior." Writing your name below indicates and electronic signature. *
Your answer
Parents, please read the following, "I understand that this is a voluntary program and there is no fee for participation. I further understand that my child(ren) may be dismissed from the program for inappropriate behavior." Writing your name below indicates and electronic signature. *
Your answer
Parents, please type your full name to indicate an electronic signature that you have read the running club permission slip and give your child permission to participate in the 2019-2020 Running Club program at Binford Elementary. *
Your answer
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