U.S. Achilles Athlete With Disability Membership Application
TERMS AND CONDITIONS: I know that participating in Achilles running or other athletic events is potentially hazardous. I agree not to enter any Achilles race, activity, or sponsored event unless I am medically able and properly trained. I agree to abide by any decision of a race official relative to my ability to safely complete the run. I assume all risks associated with participating, including, but not limited to: falls, contact with vehicles, other participants, spectators, or others, the effect of the weather, including high heat, extreme cold and/or humidity, traffic conditions of the road, all such risks being known and appreciated by me.
I understand that (1) participation with Achilles International is strictly voluntary, and (2) I am only to receive/provide running companionship, advice, and encouragement from my fellow Achilles athletes/volunteers/guides. If anything else is asked of me, or if I am otherwise uncomfortable or concerned, I will bring it to the immediate attention of my chapter leader.
Having read this Waiver and knowing these facts, and in consideration of your accepting my application, I, for myself or for my child and anyone else entitled to act on my behalf, waive and release, and agree to indemnify and hold harmless the local chapter of Achilles International to which I belong (including all local Chapter directors, officers, leaders, members, athletes, volunteers, guides), the local county and city departments of Parks and Recreation, Achilles International (aka Achilles Track Club), Achilles Kids Program, New York Road Runners, Road Runners Club of America, The City of New York and all its agencies, all sponsors of Achilles and any of their races or events, members and volunteers, from present and future claims and liabilities of any kind, known or unknown, arising out of my participation in any Achilles event or related activities, even though that liability may arise out of ordinary negligence or fault on the part of the persons named in this Waiver. By registering for a New York Road Runners Race or any other race through Achilles International, I hereby grant my permission to Achilles International to act as proxy on my behalf for that race with full authorization to execute consents, waivers and releases included in the Achilles International registration. I further grant my permission to all the foregoing to use photographs, motion pictures, recordings, or any other record of my participation in Achilles International for any legitimate purpose, without remuneration.
If applicant is under the age of 18 years of age, OR otherwise potentially deemed incompetent and/or unable to legally consent for themselves, personal information for a parent or guardian must be provided before submission.
If for any reason, the applicant is unable to read this document clearly and independently, then the document must be read to the volunteer/member, and then witnessed and co-signed by a third party individual.
Waiver Agreed To?
IN COMPLETING AND SUBMITTING THIS FORM, I INDICATE THAT I HAVE READ, UNDERSTOOD, AND AGREE TO THE ABOVE TERMS AND CONDITIONS.
Yes, I agree
Address Line 1
Address Line 2
State / Commonwealth / Territory
Preferred Phone Number
Please indicate type: cell, home, work
Date of Birth
Do you use a handcycle, pushrim wheelchair or other equipment for racing?
Name of Local Chapter
For a list of U.S. Chapters, please visit
Arizona - Greater Phoenix
Arizona - Tucson
Arkansas - NW
California - Bay Area San Francisco
California - Los Angeles
Colorado - Boulder
Colorado - Denver
Colorado - Pikes Peak
DC - Washington
Florida - Central (Orlando area)
Florida - South (Broward, Dade, Palm Bch)
Florida - South West (Naples/Fort Myers)
Illinois - Chicago
Maryland - Eastern Shore
Massachusetts - Boston
Missouri - St. Louis
Nevada - Las Vegas
New York - Brooklyn
New York - NYC Central Park
New York - Queens
New York - Westchester
North Carolina - Charlotte
Pennsylvania - Philadelphia
Pennsylvania - Pittsburgh
Rhode Island - Providence
South Carolina - Greenville
Tennessee - Nashville
Texas - Houston Memorial Park
Utah - Salt Lake City
Wisconsin - Madison
I do not know. Please advise.
Do you want to receive communications from Achilles International?
Is there anything else you would like us to know?
If applicant is under the age of 18, OR otherwise potentially deemed incompetent and/or unable to legally consent for themself, enter the name of parent or guardian, along with phone number below.
If you are acting as a 3rd party witness to a reading of the waiver, please provide your name and phone number below.
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