261 Fearless Club Texas Hill Country - Member Information & Waiver
Email address *
Name *
Address *
Address Line 2
City *
State *
Zip Code *
Cell Phone Number *
May all coaches store your number and emergency contact info in their cell phone? *
Date of Birth *
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Emergency Contact Name *
Emergency Contact Number *
Do you have any medical problems e.g. asthma, heart problems, high blood pressure, epilepsy? Give details below.
Are you taking any medications? Please list below.
How much running have you done before? State complete beginner or what distance you have achieved and rough dates?
How did you hear about us? *
I hereby agree and acknowledge that participation in group running sessions, races and other forms of physical exercise could lead to injury or death. *
I hereby agree that I will not participate in any Club events, meet runs or social events, unless I am medically able. By my signature, I hereby certify that I am (a) 18 years of age or older, (b) medically able to engage in strenuous physical activity and to perform all activities associated with the 261 Fearless Club and (c) in good health,. I hereby further assume all risk, foreseen and unforeseen, relating to any of the foregoing certifications being untrue or inaccurate in any way. *
I hereby agree to abide by all rules established by the 261 Fearless Club, including the right of any Club official to deny or suspend my participation for any reason whatsoever. I attest that I have read the rules of the 261 Fearless Club and agree to abide by them. I assume all risks (x) associated with being a member of this Club, and/or (y) participating in Club activities, which risks may include but are not limited to: falls, physical contact with other participants, the effects of the weather, including high heat and/or humidity, traffic and the conditions of the running courses, all such risks being known to and accepted by me. I understand that bicycles, skateboards, baby joggers, roller skates or roller blades, animals, and personal music players are not allowed to be used in Club-organized activities and I agree to abide by this rule. *
Having (i) read and fully understood this waiver, and (ii) agreed and accepted each of the terms of this waiver, and in consideration of the Club‘s acceptance of my membership, I, for myself and any person or entity entitled to act on my behalf, waive and release 261 Fearless Club Texas Hill Country, and 261 Fearless Inc., all Club sponsors, together with their respective officers, directors, employees, volunteers, representatives and successors from all actions, causes of action, suits, sums of money, accounts, covenants, contracts, agreements, promises, damages (both actual and consequential), judgments, claims, counterclaims and demands whatsoever, in law, or equity (collectively, “Liability”) arising in connection with my participation with the Club and/or any of its activities, even though any such Liability may arise out of negligence or carelessness on the part of the Club or any of its officers, directors, employees or volunteers. I further hereby grant the Club permission to use photographs, motion pictures, recordings of myself or any other record of my participation in Club activities solely for the Club’s promotional purposes. I hereby grant the Club permission to send me emails and information about the 261 Club. *
Today's Date *
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Entering your name below and clicking Submit constitutes your legal agreement to the form *
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