2019 Nutmeg Elite Running
Athletes Last Name *
Athletes First Name *
Gender *
Athletes Date of Birth *
MM
/
DD
/
YYYY
Street Address *
City/Town *
State *
Zip Code *
Athletes USA Track & Field Number *
Must be a current number for this year,
What grade is your child entering? *
Parents Full Name *
Parents cell phone *
For emergencies
Parents Email *
For distribution list
Second email
For distribution list
Medical Concerns *
N/A if none
List any successful modifications or concerns that will help us in coaching your child
How did you hear about Nutmeg Striders? *
T-Shirt Size *
Best Track Performances *
800m, 1600m, 3200m, 5000m, Time, date and location
Best Cross Country Performances *
Dual meets, Conference Championship, State Meet, Time, place finish, date, and location
List two goals for the Summer. *
What do you need to work on? hills, speed, endurance, etc...
List realistic goals for your fall Cross Country season. *
Times for 5k and placement in championships.
What is your max heart rate? *
N/A if not known
What is your threshold heart rate? *
N/A if not known
What pace do typically run your distance runs in? *
Example: 7:30/mile
Have you had any recent injuries? *
Injury and date.
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. *
Submit
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