Brisbane Run Squad Membership Form 2015-2016 NEW MEMBERS

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Please complete the following form to become a member of the Brisbane Run Squad.
It is important that you answer medical questions honestly to ensure we are aware of any relevant injuries or medical conditions. Your personal and medical information will be kept confidential.

First Name *

Surname *

Date of Birth *

Contact Phone Number (preferably a mobile) *

Email Address *

Please note: you will only be added to the BRS email distribution list upon payment of the $30.00 membership fee.

Emergency Contact Name *

a person for coaches to contact in case of emergency

Emergency Contact Contact Number *

Injuries

Please list any injuries that coaches should be aware of that may impact your ability to run and train effectively

Medical Conditions

Please list any medical conditions that you believe coaches should be aware of, and any medications you are required to carry whilst you run

Goals

We are interested in your running & fitness goals for this year, we would love you to share them!

BRS Member Terms & Conditions: In the interests of maintaining a safe and enjoyable training environment, we request BRS Members to read and agree to Membership Terms and Conditions available *

RELEASE FOR PARTICIPANTS OF BRISBANE RUN SQUAD’S TRAINING SESSIONS * BRISBANE RUN SQUAD MEMBERSHIP is contingent upon completion of this form I understand and acknowledge the inherent risk of participating in strenuous physical activity and the potential for harm and injury to participants that may result. I agree that I participate at my own risk and that Brisbane Run Squad and its affiliates shall not be liable for any personal injury, death, loss or damage occasioned by me or any loss or damage occasioned to any of my possessions, whether such liability arises out of any express or implied term of my participation in the training session or at common law or in any other way. I agree to inform the coaches of any pre-existing injuries which may affect my participation in the training event and/or to immediately report any injury I may suffer whilst participating in this event and the manner of the occurrence of such injury. I agree to follow the rules and directions of the coaches and understand that any misconduct or refusal by me to follow any direction of the coaches will result in the cancellation of my participation in the exercise without refund and may result in membership review. I agree that I have consulted with my medical service provider if required to prior to participation in any Brisbane Run Squad organised activities. Effect of this document I understand that my signature to this document constitutes a complete and unconditional release of all liability of Brisbane Run Squad’s organisers and their associates to the greatest extent allowed by law in the event that I suffer property damage, personal injury, illness or death as a result of participation in the training event.

I agree

I am not willing to agree

Please deposit your membership fee of $30: CUA Renae Jones BSB 814 282 ACCT 31099466. If we do not receive payment in 3 days, you will receive an invoice for payment with multiple payment options. When payment is received, we will provide you with a BRS Membership Card available at BRS training sessions.

Thank-you for becoming a BRS member

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Forms