2019 Nutmeg Elite Running
Athletes Last Name *
Your answer
Athletes First Name *
Your answer
Gender *
Athletes Date of Birth *
MM
/
DD
/
YYYY
Street Address *
Your answer
City/Town *
Your answer
State *
Your answer
Zip Code *
Your answer
Athletes USA Track & Field Number *
Must be a current number for this year,
Your answer
What grade is your child entering? *
Parents Full Name *
Your answer
Parents cell phone *
For emergencies
Your answer
Parents Email *
For distribution list
Your answer
Second email
For distribution list
Your answer
Medical Concerns *
N/A if none
Your answer
List any successful modifications or concerns that will help us in coaching your child
Your answer
How did you hear about Nutmeg Striders? *
T-Shirt Size *
Best Track Performances *
800m, 1600m, 3200m, 5000m, Time, date and location
Your answer
Best Cross Country Performances *
Dual meets, Conference Championship, State Meet, Time, place finish, date, and location
Your answer
List two goals for the Summer. *
What do you need to work on? hills, speed, endurance, etc...
Your answer
List realistic goals for your fall Cross Country season. *
Times for 5k and placement in championships.
Your answer
What is your max heart rate? *
N/A if not known
Your answer
What is your threshold heart rate? *
N/A if not known
Your answer
What pace do typically run your distance runs in? *
Example: 7:30/mile
Your answer
Have you had any recent injuries? *
Injury and date.
Your answer
By selecting "Submit" on the registration displayed below you are acknowledging that you have read and voluntarily agree to the following Nutmeg Striders Membership Waiver: I know that conditioning exercises, running or competing in track and field events are potentially hazardous activities. I should not enter and participate in club activities unless I am medically able and properly trained. I agree to abide to any decision of a club official relative to my ability to safely complete. I assume all the risks associated with cross country running, road racing, and track and field including, but not limited to: falls, contact with other participants, the effects of weather, including high heat and/or humidity, the conditions of the road and traffic on the course, the conditions of the running trails, and all such risks are known and appreciated by me. Having read this waiver and knowing these facts, and in consideration of your acceptance of my application for membership; I, for myself and anyone entitled to act on behalf, waive and release Nutmeg Striders LLC, and all sponsors and their representatives and successors from all claims or liabilities of any kind rising out of my participating in club carelessness activities, even though that liability may arise out of negligence or on the part of the persons named in this waiver. *
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