Achilles Kids Membership Form
CHILD'S Name *
Your answer
CHILD'S Birthdate *
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DD
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YYYY
CHILD'S Gender *
DISABILITY (please specify) *
Your answer
Does your child have any medical or behavioral considerations we should be aware of? (if yes, please specify) *
Your answer
Parent's Name(s) *
Your answer
Address (include Apt #) *
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
Cell Phone Number *
Your answer
E-mail *
Your answer
Name of Sibling #1 who is participating in Achilles Kids
Your answer
Birthdate of Sibling #1
MM
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DD
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YYYY
Gender of Sibling #1
Name of Sibling #2 who is participating in Achilles Kids
Your answer
Birthdate of Sibling #2
MM
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DD
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YYYY
Gender of Sibling #2
Please read the following waiver and indicate that you have read, understood and agree to the terms by entering your name and date below.
WAIVER: In consideration of your accepting membership, I the undersigned, intending to be legally bound, hereby, for my child(ren), myself, my heirs, executors, and administrators, waive and release any and all rights and claims for damages that I may have against Achilles International, Achilles Kids Program, and its officers and employees, supporting organizations, and volunteers, and the representatives, successors, and assigns of such organizations and individuals, for any and all losses or injuries suffered by my child(ren) or myself in connection with my participation in and travel to workouts, races and recommended practices. I attest my child(ren) to be in proper physical condition for exercise and have been recently examined by a qualified physician. I know that participating in running activities is a potentially hazardous activity, and I assume all risks for my child(res) associated with running/walking/rolling in any Achilles Kids races or workouts, including, but not limited to, falls, contact with other participants, the effects of the weather, including high heat and/or humidity, all such risks being known and appreciated by me. I, for my child(ren), and for myself, and anyone entitled to act on my behalf, waive and release any and all sponsors including, but not limited to, Achilles International, Achilles Kids, City of New York, New York Cares, their representatives and successors from all claims or liabilities of any kind arising out of my participation in these club activities. Further, I hereby grant full permission to the Achilles International to use for any legitimate purpose any photographs, video tapes, audio recordings, or any other report or recording of my participation.
SIGNATURE *
Your answer
I would like to receive weekly emails about upcoming events. (Please note your email address is never shared). *
Date *
MM
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DD
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