SRR Kids Fall 2019 Sign Up Form
Please fill out the following form to enroll your child in the Fall 2018 SRR Kids program. If registering multiple children, please fill out a separate form for each child. Please contact us at
with any questions. Thank you!
Parent/Guardian #1 First & Last Name
Parent/Guardian #2 First & Last Name
List the primary contact email. We will be emailing regularly with practice information, notice of cancellation, etc. Please list two (2) if you want both parents/guardians contacted.
Emergency Contact Name
Relationship to Child
Emergency Contact Telephone Number
I authorize SRR to share my contact information with other parents
Parents often find it useful to have a contact roster to help with carpooling or setting up playdates with their child's new friends. This information will only be shared with other SRR Parents/Guardians.
I authorize SRR to use photos of my child on its website or in print materials to help promote the program
Participating child's first and last name
Child's parent is a member of Somerville Road Runners
Child is a Somerville resident
Prefer not to answer
Does your child play other sports?
School child attends
East Somerville Community School
Capuano Early Childhood
Next Wave and Full Circle
West Somerville Neighborhood
Winter Hill Community School
After attending 5 practices, children will receive a t-shirt (cotton blend). All sizes are "Youth"
Special Needs/ Allergies
Please list any allergies, special needs or notes about your child that SRR should be aware of to help make your child's experience the best possible.
Does your child have any friends participating?
If so, we can try to put them in the same group together. All the kids will have an opportunity to run together regardless of which group they are assigned to.
I, the undersigned, am the parent or legal guardian of the minor child whose name appears below. I know that running is a potentially hazardous activity. I know that the minor child should not run unless medically able. I agree to abide by any decision of the program director relative to the minor child’s ability to safely complete the risks associated with running in this program including, but not limited to: falls, contact with other participants, the effects of the weather, including high heat and/or humidity, traffic and the conditions of the road or track, all such risks being known and appreciated by me. Having read this waiver and knowing these facts, on my behalf and the minor child’s behalf, waive and release Somerville Road Runners, the Road Runners Club of America, its officers, directors, agents, employees, sponsors, their representatives and successors from all claims or liabilities of any kind arising out of the minor’s participation in this event even though that liability may arise out of negligence or carelessness on the part of the persons named in this waiver. I further authorize and empower the program director to consent to and authorize any medical care or treatment for the minor that may appear reasonably necessary as a result of emergency, accident or illness of the minor whether occurring before, during or after the event. I grant permission to all of the foregoing to use any photographs, motion pictures, recordings, or any other record of this for any legitimate purpose. I understand that personal music players are not allowed for use in this program, and I will ensure the minor abides by this guideline.
No, I do not agree to the waiver (your child will not be permitted to participate)
We are looking forward to another great season. If you would like to volunteer with SRR kids or if you would like to pace your child at the season ending race, please contact
Anything else we should know?
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