Washington D.C. Rock 'N' Roll Half Marathon and Marathon Training Program by Metro Run and Walk
Thank you for your interest in the
Washington D.C. Rock 'N' Roll Half Marathon and Marathon Training Program
by Metro Run and Walk!

INSTRUCTIONS:  Please complete this application as accurately and as fully as possible.  All sections are required.  All information will be held strictly confidential and will not be shared outside of the program or with other participants.

16-Week Session
11/28/2011 - 5/17/2012
$175

12-Week Session
01/10/2012 - 5/17/2012
$150

Payable by credit card online (VISA, MASTERCARD, DISCOVER, AMEX), & cash, credit card (VISA, MASTERCARD, DISCOVER, AMEX), or check (PAYABLE TO "METRO RUN & WALK") at Metro Run & Walk.

Metro Run & Walk
7261 Commerce Street
Springfield, VA 22150
703-913-0313
www.metrorunwalk.com

RUN WALK LIVE!!!





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BASIC CONTACT INFORMATION
LAST NAME *
FIRST NAME *
STREET ADDRESS *
CITY *
STATE *
ZIP CODE *
PHONE NUMBER *
E-MAIL *
EMERGENCY CONTACT INFORMATION
EMERGENCY CONTACT NAME *
EMERGENCY CONTACT PHONE NUMBER *
TRAINING PROGRAM SESSION
INDICATE WHICH SESSION YOU WOULD LIKE TO SIGN UP FOR *
INDICATE FORM OF PAYMENT *
16-WEEK SESSION @ $175/ 12-WEEK SESSION @ $150
FREE Metro Run and Walk Technical T-Shirt *
Unisex Sizes
How did you hear about the Washington D.C. Rock 'N' Roll Training Program by Metro Run and Walk? *
GOOD FORM RUNNING
GFR by Metro Run and Walk - FREE to program participants!
Go to www.metrorunwalkspringfield.com/training/goodformrunning.html to register
Have you participated in a Good Form Running (GFR) class? *
EXERCISE QUESTIONNAIRE
Describe your current exercise program.
How often do you exercise? *
How long is each workout session? *
How long have you participated in your current exercise program? *
What exercise activities do you participate in? *
Check all that apply.
Required
Have you completed a long distance event in the past? *
If "YES," what has been your longest DISTANCE event, WHEN did you participate in the event, and what was your TIME?
What long distance event(s) would you like to prepare for currently? *
Check all that apply.
Required
In addition to achieving your training goal of completing a long distance event, please indicate the importance of the exercise goals listed below. *
Not Important
Somewhat Important
Important
Extremely Important
N/A
GAIN STRENGTH
IMPROVE FLEXIBILITY
LOSE WEIGHT
INCREASE ENDURANCE
INCREASE SPEED
What other goals would you like to accomplish through this training program? *
Have you started an exercise program in the past or joined a gym and stopped going?  If YES, please explain. *
WAIVER AGREEMENT
GENERAL ASSUMPTION OF RISK AND RELEASE OF LIABILITY

Caution: This is a release of legal rights. Read and understand it before signing. Runner Runner Enterprises LLC(trading as Metro Run & Walk) is a for profit company. Reference to Runner Runner Enterprises, LLC includes all its officers, staff, volunteers, agents, and assigns. I freely choose to participate in the Metro Run & Walk running club and/or training programs (henceforth referred to as METRO RUN & WALK Training Program). In consideration of my participation in the Metro Run & Walk Training Program, I agree as follows:

RISKS INVOLVED IN FIRST STEP AND/OR DISTANCE TRAINING PROGRAM:


I am aware that running, practicing, training, and/or other involvement in any sport can be a dangerous activity involving MANY RISKS OF INJURY, including, but not limited to the potential for catastrophic injury. I understand that the dangers and risks of running, practicing, or training in any athletic activity include, but are not limited to, death, serious neck and spinal injuries which may result in complete or partial paralysis or brain damage, serious injury to virtually all bones, joints, ligaments, muscles, tendons, and other aspects of the muscular-skeletal system, and serious injury or impairment to other aspects of my body, general health and well-being. Because of the dangers of participating in any athletic activity, I recognize the importance of following all instructions of the coaching staff and/or Sports Medicine Staff.



HEALTH AND SAFETY:


I have been advised to consult with a medical doctor with regard to my personal medical needs. I state that there are no health-related reasons or problems that preclude or restrict my participation in the Metro Run & Walk Training Program. I recognize that Metro Run & Walk is not obligated to attend to any of my medical or medication needs, and I assume all risk and responsibility therefore. In case of medical emergency occurring during my participation in the Metro Run & Walk Training Program, I authorize in advance the representative of Metro Run & Walk to secure whatever treatment necessary, including the administration of an anesthetic and surgery. Metro Run & Walk may (but is not obligated to) take any actions it considers to be warranted under the circumstances regarding my health and safety. Such actions do not create a special relationship between Metro Run & Walk and me. I release Metro Run & Walk, its officers, officials, employees, volunteers, agents and assigns from all liability for any bodily injury or damage I sustain as a result of any medical care that I receive resulting from my participation in Metro Run & Walk, as well as any medical treatment decision or recommendation made by an employee or agent of Metro Run & Walk. I agree to pay all expenses relating thereto and release Metro Run & Walk from any liability for any actions.



ASSUMPTION OF RISK AND RELEASE OF LIABILITY



Knowing the risks described above, and in voluntary consideration of being permitted to participate with Metro Run & Walk, I agree to release, indemnify, and defend Metro Run & Walk and their officials, officers, employees, agents, volunteers, and sponsors from and against any claim which I, the participant, my parents or legal guardian or any other person may have for any losses, damages or injuries arising out of or in connection with my participation with Metro Run & Walk.

INDICATION OF AGREEMENT:


I indicate that by my signature below by clicking "I AGREE" that I have read the terms and conditions or participation and agree to abide by them. I have carefully read this Release Form and acknowledge that I understand it. No representation, statements, or inducements, oral or written, apart from foregoing written statement, have been made. This Release Form shall be governed by the laws of the State ofVirginia which shall be the forum for any lawsuits filed under or incident to the Release Form or to Metro Run & Walk. If any portion of this Release Form is held invalid, the rest of the document shall continue in full force and effect.

DATE OF BIRTH (mm/dd/yyyy) *
Participant must be at least 18 years of age or older.
Waiver Agreement *
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