Jr. Fall Session Registration (ages 7-9)

Parent/Guardian Name

First

Last

Parent/Guardian Phone Number (555) 555-5555

Guardian Email Address

Email

Confirm Email

Child's Name

First

Last

Child's Date of Birth (MM/dd/YYYY)

Does your child have any medical conditions we should know about?

Is your child currently taking any medication?

Has your child had any injuries in the past 6 months that may affect participation?

Any allergies or other considerations?

If yes to any of the above, please elaborate:

What size shirt does your child wear? (youth sizing)

Acknowledgement

I, the undersigned parent/guardian of the above-named child, acknowledge that participation in the Rising Runners outdoor running clinic involves physical activity and carries inherent risks, including but not limited to: falls, collisions, slips, trips, sprains, strains, or other injuries. I understand that the clinic will be held outdoors on grass surfaces, which may be uneven or slippery.

Medical Considerations:

I confirm that my child is in good health and able to participate in physical activity. I have disclosed any relevant medical conditions, medications, or allergies to the organizers.

had Liability: (youth

Assumption of Risk & Release of Liability:

I voluntarily assume all risks associated with my child’s participation in the clinic. I release and hold harmless Rising Runners, its coaches, volunteers, organizers, and property owners from any liability for injury, loss, or damage that may occur during participation.

Emergency Consent:

In the event of an emergency, I authorize the organizers to obtain medical care for my child if I cannot be reached immediately. I understand that I am responsible for any medical costs incurred.

Media Release (Optional):

I consent to photos or videos of my child being used for Rising Runners promotional purposes.
I do not consent to photos or videos of my child being used for Rising Runners promotional purposes.

Parent / Guardian Signature (Full name) : By entering your name you acknowledge you have read and agree to the above waiver.

Date: (MM/dd/YYYY)