Winter1617 Registration

Winter 2016/17 Program Registration Form

* Indicates required field

Name *

First

Last

Email *

Age *

Gender *

Female Male

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Primary Day and Location you will most regularly attend *

Choose Your Pace Group *

Pick Your Coach (From a relevant Pace/Day/Time) *

Primary Winter Goal *

If other goal race, please tell us the event name and date *

Experience Level *

Beginner/Novice (1-2 yrs) Intermediate (2-4 yrs) Advanced (4 yrs +)

Current Fitness Level *

Recent PR (Last 2 yrs, Can be 5K, 10K, Half or Full) *

Any injuries or issues your coach should be aware of? *

How did you hear about Revolution Running *

If you were referred by friend or family, please give us their name *

Waiver and Release of Liability Statement.
I am aware that joining the Revolution Running Program will include running and walking and that these activities involve risks. I understand that traffic will be on group run course routes. I assume the risk of running or walking in traffic. I also assume any and all other risks associated with participating in the program including, but not limited to falls, contact with other participants and trail users, the effects of weather, including heat and/or humidity, cold, wind, snow, rain, or ice and the conditions of the roads, all such risks being known and appreciated by me. I should not participate in the Revolution Running program unless I am medically able and physically capable. I understand that I am solely responsible for my own safety while traveling to and from or participating in this program. I hereby for myself, my heirs, executors, administrators or anyone else who might claim on my behalf covenant not sue, and waive, release, and discharge Revolution Running, North Training Solutions LLC, Ewen North and Heather North or any sponsor or contributor to this program, any official or volunteer, any city or municipality, their representatives, successors or assigns, from any and all claims of liability for death, personal injury or property damage of any kind or nature whatsoever arising out of or in the course of my participation in this program. The Release and Waiver extends to all claims of every kind or nature whatsoever, foreseen, known or unknown.

By checking here you agree to the above waiver *

I agree to the above waiver.

Date of Birth *

Electronic Signature *

Refunds Policy *

I understand there are no refunds

PLEASE PAY HERE

Winter 2016/17 Program Registration Form

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