SARNIA ROAD RUNNERS

Membership 2017

 

 

Name

Sex

Age on Mar.15

Date of Birth

Shirt size

(circle one)

 

 

 

 

XS S M L XL

 

 

 

 

XS S M L XL

 

 

 

 

XS S M L XL

 

 

 

 

XS S M L XL

 

 

 

 

XS S M L XL

 

 

Runners will remain in the same age division for the entire season

 

Phone __________________ E mail ________________________________________________

 

Single membership      $40

Family membership     $50

Additional shirts         $20

 

Do you give permission for a photograph of you to be posted on Facebook? Yes __ No __

 

Signature ____________________________________________ Date ______________

 

RELEASE, WAIVER, AND INDEMNITY AGREEMENT

In consideration of the acceptance of my application to participate in and attend at Sarnia Road Runners’ Association (SRRA) events and/or activities, “I, on behalf of myself, my heirs, executors, administrators, successors and assigns, waive, release, and forever discharge the Sarnia Road Runners’ Association, its officers, representatives, agents, employees, members, organizers, officials, servants, and all participants, competitors, and entrants from and against any and all kinds of actions, claims, costs, and expenses and demands in respect of injury, death, loss or damage, occurring prior to, during, or subsequent to SRRA events and/or activities, to my person or property, howsoever caused and arising out of my being permitted to attend at, or in any way take part in SRRA events and/or activities, whether as a spectator, participant, competitor, entrant, or otherwise, and notwithstanding that the same may have been contributed to or occasioned by the negligence of any of the aforesaid.  I further hereby undertake to hold and save harmless and agree to indemnify all of the aforesaid from and against any and all liability incurred by any or all of them arising as a result of, or in any way connected with my participation in the said activity.”

 I acknowledge having read, understood, and agree to the above waiver, release, and indemnification.  I warrant that I am physically fit to participate in Sarnia Road Runners’ Association events and/or activities.

 Signature __________________________________________________            Date ___________________

Signature of Parent or Guardian ________________________________________________              Date _______________

The above parent/guardian (parent signing on behalf of family) consents to the minor’s (family members under the age of 18) participation in Sarnia Road Runners’ Association events and/or activities and acknowledge that he/she is bound by the waiver to the same extent as minor(s).