RCMS Run Club

Welcome to the Reedy Creek Middle School Run Club registration page!  
If you have any issues with your registration, please e-mail rcmsrunclub@gmail.com.

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Participant Last Name *
Participant First Name *
Date of Birth *
Age *
Address - Street, City, State, Zip Code *
Phone number: *
Please indicate below if this is a home, work, or cell number.
Type *
Required
Alternate phone number
Type
E-mail address *
I am a ... *
Please select your status with RCMS below.
Student grade level and homeroom teacher *
Please type in "n/a" if you are a staff member, parent or guardian, or other status.
WCPSS Volunteer Registration status *
WCPSS Volunteer Registration is available on Mondays from 8am to 4pm at any WCPSS faciility.  Please fill in estimated date of completion in the "Other" box below.  Participation in the Run Club will not be allowed until successful acknowledgement from WCPSS has been received.
Required
As a student at RCMS, I understand the rules and policies of WCPSS still apply.  As a non-student participant, I understand that I am also held to the rules and policies of WCPSS. *
Please type your name in the box below as your digital signature and agreement to follow all rules and policies of the WCPSS.
Medical concerns *
Please list any medical concerns the coordinators should be aware of.  Please include any allergies, medications used regulary or for emergencies, whether you wear glasses, contact lenses, have a dental appliance, or any other pertinent medical information.  All information provided will be kept confidential.
Insurance Provider (Optional)
Insurance Policy or Group Number (Optional)
Family Physician and Phone Number (Optional)
Preferred Hospital *
Every effort will be made have your choice, however the final say lies with medical professionals on scene.
Emergency Contact Person *
This information must be provided for all participants in the event you are incapacitated and unable to make a decision for yourself at the time.
Telephone number *
Alternate telephone number *
Relationship to participant *
Alternate Emergency Contact and Phone Number (Optional)
Medical Authorization
As the parents or legal custodian of the student athlete, I grant permission for treatment deemed necessary for a condition arising during or affecting participation in sports, including medical or surgical treatment recommended by a medical doctor.  I understand that every effort will be made to contact me prior to treatment.  As a non-student participant, being a staff member, parent, guardian, or other, I grant permission for treatment deemed necessary for a condition arising during or affecting participation in sports, including medical or surgical treatment recommended by a medical doctor if I am unable to grant permission for myself at the time.  I understand the every effort will be made to contact the person listed in my emergency contact prior to treatment.  Also, permission is granted to release medical information to WCPSS, Reedy Creek Middle School, and the athletic trainer.  This permission is valid during the entire duration the student athlete is enrolled at Reedy Creek Middle School, unless revoked by the parent or legal guardian in writing.  This permission is valid for the non-student participant, being a staff member, parent, guardian, or other, during the entire duration the non-student participant, being a staff member, parent, guardian, or other, is participating in this athletic program, unless revoked in writing.
By checking the box below, I acknowledge that I have read the "Medical Authorization" statement and I have the authority to make decisions for the student participant, or if I am the participant, I am of the legal age of consent. *
If you do not agree to the "Medical Authorization" statement above, regretfully, your participation will not be allowed in the RCMS Run Club.
Required
Risk of Injury
I acknowledge and understand that there is a risk of injury in athletic participation.  I understand that the student athlete will be under the supervision of a WCPSS athletic coach and/or staff member.  I agree to follow the rules of the WCPSS athletic coach or staff member in order to reduce the risk of injury to the student and other athletes and participants.  I acknowledge and understand that neither the coach or staff member, nor WCPSS, can eliminate the risk of injury in sports.  Injuries may and do occur.  Sports injuries can be severe and in some cases, may result in permanent disability or even death.  I freely, knowingly, and willfully, accept and assume the risk of injury that might occur from participation in athletics.
By checking the box below, I acknowledge that I am the legal guardian and have the authority to make decisions for the participant, or if I am the participant, I am of the legal age of consent.  I further acknowledge I have read the "Risk of Injury" statement above in its entirety.   *
If you do not agree to the "Risk of Injury" statement above, regretfully, your participation will not be allowed in the RCMS Run Club.
Required
Please type your name in the box below as your digital signature of the registration form before hitting submit. *
If you choose, you may print a copy of this form for your records from your web browser.  A paper copy will not be provided to you.
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