High School And Junior Race Form printable pdf download

HIGH SCHOOL AND JUNIOR RACE FORM

PLEASE PRINT ALL INFORMATION

NAME OF RACE _________________________________________________________________

BIB #_________

SEX (circle) Male Female

Age______ Date of Birth __________________

Month/day/year

NAME:______________________________________________________________

(last)

(first)

(middle initial)

ADDRESS:___________________________________________________________

CITY:____________________________STATE:_________________ ZIP:____________

(circle one) HIGH SCHOOL TEAM MEMBER

“OR”

INDIVIDUAL COMPETITOR

HIGH SCHOOL TEAM:_____________________________________________________

AGE CLASS (circle)

9-11

12-13

14-15

16-18

DISTANCE:

____________________________

AMATEUR ATHLETIC - WAIVER AND RELEASE OF LIABILITY

You must sign the Liability Waiver or have your parent/guardian sign if under 18

In consideration of being allowed to participate in any way in an athletics/sports program, and related events and activities:

I agree that prior to such participation, I will, or , if I am the parent or guardian of a minor participant will instruct such participant that he or she should,

inspect the facilities and equipment to be used, and if I believe anything is unsafe, I will immediately advise my coach (if I am participating as an athlete) or

a supervisor of such condition(s) and refuse to participate.

I acknowledge and fully understand that I may be engaging in activities that involve risk of serious injury, including permanent disability and death, and

severe social and economic losses which might result not only from my own actions, inactions or negligence but the actions, inactions, or negligence

of others, the rules of play, or the conditions of the premises or of any equipment used. Further, that there may be other risks not known to me or not

reasonably foreseeable at this time.

I assume all the foregoing risks and accept personal responsibility for my personal damages following my injury, permanent disability or death.

Intending to be legally bound, I do hereby release, waive, discharge and covenant not to sue the sponsoring organization, it’s affiliated clubs, their respective

administrators, officers, directors, agents and other employees or volunteers of the organization, other participants, sponsoring agencies, sponsors,

advertisers, and if applicable, owners and leasers of premises used to conduct the event, all of which are hereinafter referred to a “releases”, from any and all

liability to me, my heirs and next of kin for any claims, demands, losses, or damages on account of injury, including death or damage to property, caused or

alleged to be caused in whole or in part by the negligence of any releases or otherwise in connection with association of participation in and/or arising out of

my travel to , participation in and returning from participation in the event.

In the event that I sustain injury or illness while participating, I hereby authorize any emergency first aid, medication, medical treatment or surgery deemed

necessary by licensed medical personnel. I also give my permission for attending medical personnel to execute on my behalf my permission forms or other

necessary medical documents and to act in my behalf if I am not immediately available to do so.

THE UNDERSIGNED HAS READ THE ABOVE WAIVER AND RELEASE, UNDERSTAND THAT HE/SHE HAS GIVEN UP SUBSTANTIAL RIGHTS

BY SIGNING IT AND SIGN IT VOLUNTARILY.

I HAVE READ THIS RELEASE AND WILL COMPLY WITH ITS PROVISIONS..

SIGNATURE________________________________________________PRINTED NAME____________________________________DATE_______________

FOR ATHLETES OF MINORITY AGE

This is to certify that, as a parent/guardian of this participant, I do consent to his/her agreement to be bound by each of the terms and conditions identified above.

PARENT/GUARDIAN SIGNATURE____________________________________________________________DATE SIGNED_____________________________