Strength for Runners - Registration June 2020
First and Last Name *
Your answer
Best E-mail address to contact you *
Your answer
Emergency Contact Phone Number *
Your answer
Would you like to register for a class starting next week?
3 person classes will be filled in order that this form is received. Once your spot is confirmed, I will email you a PayPal link. thank you!!
Date you'd like to sign up for?
Is there a better time/date that you'd prefer? Details. (I am willing to change the time if there are 2-3 people who would like that day/time.)
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Would you be interested in a different format?
Are there precautions/recommendations/concerns you'd like me to know/take into consideration? Any additional questions or information you think I should be aware of?
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The Legal Stuff
The parties agree that this agreement may be electronically signed. The parties agree that the electronic signatures and statements of "I agree" appearing on this agreement are the same as handwritten signatures for the purposes of validity, enforceability, and admissibility. THIS FORM MAY BE PRINTED OUT AND TURNED IN TO ACT RUNNING MANUALLY. *
If you are planning to become much more physically active than you are now, start by answering the seven questions in the box below. If you are between the ages of 15 and 69, the PAR-Q will tell you if you should check with your doctor before you start. If you are over 69 years of age, and you are not used to being very active, check with your doctor first.Please read the questions carefully and answer each one honestly. Check the boxes to answer yes. Leave blank for no. If you choose yes for any of the boxes, please explain below. You may be advised to get a doctor's approval before beginning physical exercise. *
Required
If you answered Yes to any of the PAR-Q please explain.
Your answer
I understand that I will be billed via PayPal invoice for 1 month. I agree that I will take personal responsibility for maintaining my personal health by not attending if I have a fever, any signs of illness and will practice good hygiene. I also understand that I will be expected to bring a face mask to all sessions and wear it when I am unable to maintain a distance of 8+ feet or follow CDC guidelines. *
APPLICANT INFORMATION FORM AND RELEASE OF LIABILITY- ACT RUNNING LLCDisclosure: Appreciation of Risk involved in Race/Sport/Training/Team-Building/Challenge Course/Group Runs and Media Release:ACT Running LLC programs involve a variety of activities that often include warm-up, games, group initiative problems, low and high challenge course elements and other rigorous physical adventure activities. The level of participation in all programs and activities is at all times completely up to the individual. Yet there is a risk which must be assumed by each participant that he or she may suffer an emotional or physical injury and disability. Policy for participation in all ACT Running LLC programs requires that every participant have health/accident insurance coverage. In addition, certain health/medical information must be made known to the instructors/volunteers conducting programs so that they are prepared to respond appropriately if the need arises. This information will be held in confidence. Challenge by ChoiceRunning, walking events/activities and team-building programs are composed of activities that may be very unfamiliar to all participants. To assure our participants control over their own personal safely, we have adopted the philosophy of “Challenge by Choice”. At all times, participants in ACT Running LLC activities are completely in control of their own level of participation. During our programs you only need to do or attempt to do only those things that you choose. You must listen carefully to all instructions and briefings, set your own goals free of the influence of the group’s goals, make a decision as to your level of participation and inform others of your choice. You must be aware/accept responsibility for possible risks in this program:I, the undersigned, assume and understand that there are inherent risks of bodily injury and even death or damage to property, that are not the fault of ACT Running LLC that accompany my participation in ACT Running LLC activities. I acknowledge and agree that participation in the activities and training exposes me to risks including, but not limited to, falls, running-related injury, conditions of the road and traffic, contact with other participants, effects of weather, high-heat and/or humidity, and any other such risks, known and unknown. I know that running is a potentially hazardous activity and certify that I am in good health and physically fit to enter into an activity or training program and that my physical condition has been verified by a licensed Medical Doctor. I acknowledge that I am aware of the many risks of injury or other conditions involved in athletic training in general and running training specifically, including conditions or injuries which could be life threatening. I have read the previous paragraphs and I know, understand, and appreciate these and other risks that are inherent in training for and participating in road, trail and track running and racing and any conditioning and cross training activities associated with that training. I hereby assert that my participation is voluntary and that I knowingly assume all such risks.Indemnification and Hold Harmless: I also agree, at my own expense, to INDEMNIFY AND HOLD HARMLESS ACT Running its agents, representatives, mentors, volunteers, sponsors, successors and family 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 ACT Running's program.Severability: I further expressly agree that the foregoing waiver and assumption of risks agreement is intended to be as broad and inclusive as is permitted by the law of the State of Texas and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.Acknowledgment of Understanding: I have read this waiver of liability, assumption of risk, and indemnity, and responsibility agreement above, fully understand its terms, and I understand that I am giving up substantial rights, including my right to sue. I acknowledge that I am accepting the agreement freely and voluntarily, and intend by my registration to be a complete and unconditional release of all liability to the greatest extent allowed by law. I further grant ACT Running LLC and ACT Running LLC persons acting for or through them , the right to use, reproduce, assign and/or distribute photographs, films, videotapes, and sound recordings of myself for use in materials/marketing they may create. I am at least eighteen (18) years of age and fully competent and I execute this waiver of liability for full, adequate, and complete consideration fully intending to be bound by the same. This agreement shall be governed by the laws of the State of Texas and enforced by the courts therein.GROUP WAIVERAcknowledgement of Understanding: I acknowledge that I have read the attached Waiver of Liability, Assumption of Risk, and Indemnity Agreement and fully understand its terms. I affirm that I am voluntarily participating in the ACT Running LLC event and further acknowledge that I know, understand, and appreciate the inherent risks of the ACT Running LLC Event. I assume full responsibility for any and all injuries or damages which may occur to me as a result of the inherent risks associated with ACT Running LLC event.I understand and agree to the Waiver of Liability, Assumption of Risk, and Indemnity Agreement *
Thanks for your interest in ACT Running Programs!
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