MCPS Well Aware Fall 2024 Training Program
This 9-week virtual training program begins on Tuesday, September 3rd and runs through Sunday, November 3rd. Participants will be prepared to participate in the https://www.rockville10k5k.com/ (optional, additional registration cost). It is appropriate for beginner runners as well as those with some previous running experience, including participants in prior programs. Training program materials will be distributed on Friday, August 30th.  Please complete the form below to register. Questions?  Email us at JulieandLisa@runfartherandfaster.com.  We look forward to helping you reach your goals this semester!
Sign in to Google to save your progress. Learn more
First Name *
Last Name *
Email Address (please use MCPS email address) *
Phone Number *
Street Address *
City *
State *
Zip Code *
If applicable, name of school (or central office)
Please list all medications (including over the counter) that you take on a regular or intermittent basis:
Please indicate if you have been diagnosed with any of the following conditions:
Have you had any recent injuries? If so, please describe, including date, diagnosis and medical treatment (physical therapy, surgery,etc.)
Select the following that best describes your current level of running: *
Have you been professionally fit for running shoes at a running store or by a medical professional (physical therapist, podiatrist)? *
When did you purchase your most recent pair of running shoes? *
Describe your goals for this program:
Please provide us with any other information you believe is relevant to your successful participation in this program:
INITIAL TO ACCEPT: Waiver and Release: In consideration of being permitted to participate in Lisa Levin & Julie Sapper's Training Program through Run Farther & Faster, LLC, I, for myself, my heirs, personal representatives and assigns, do hereby release, waive, covenant not to sue and discharge Lisa Levin, Julie Sapper, and Run Farther & Faster, LLC from liability from any and all claims including the negligence of Lisa Levin and/or Julie Sapper resulting in personal injury, accidents or illnesses (including death), and property loss arising from, but not limited to, participation in a running, walking, cycling, swimming or multisport training program. *
INITIAL TO ACCEPT: Assumption of Risks: Participation in physical activity and conditioning programs carries with it certain inherent risks that cannot be eliminated regardless of the care taken to avoid injuries. I know that exercise is a potentially hazardous activity and certify that I am in good health and physically fit to enter into a general conditioning program. I acknowledge that I am aware of the many risks involved in various forms of exercise in general and running training specifically, which risks include by way of example and not limitation: 1) minor injuries such as scrapes, bruises, sprains and strains, 2) more serious injuries such as joint, muscle and bone injuries, concussions and other head injuries, heat related injuries such as heat stroke and heat exhaustion, dehydration and over hydration conditions such as hyponatremia, and catastrophic injuries and conditions such as heart attacks and other conditions or injuries which could be fatal. I have read the previous paragraphs and I know, understand, and appreciate these and other risks that are inherent in walking, running, exercising and training for general conditioning and health improvement. I hereby assert that my participation is voluntary and that I knowingly assume all such risks. *
INITIAL TO ACCEPT: Indemnification and Hold Harmless: I also agree to INDEMNIFY AND HOLD HARMLESS Run Farther & Faster, LLC, Lisa Levin, Julie Sapper and their agents from any and all claims, actions, suits, procedures, costs, expenses, damages and liabilities, including attorney’s fees brought as a result of my involvement in Run Farther & Faster’s Training Program *
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms