Longview Running Club Half Marathon Training Program 2014

Please give us a bit of information about your running background. (please print)

Name_________________________________________________________________ Age__________________ Male Female

Address_______________________________ City___________________ State_____ Zip_________ Phone___________________________ email______________________________________________

How long have you been running? _______ _______ _______ _______ _______ Just getting started Less than 6 months 6 months to 2 years 2 7 years more than 7 years

How many half marathons have you completed? _______ _______ _______ _______ The Longview Half will be my first One Two More than two

Approximately how many miles, (average), have you run each week during the last 6 weeks? _______ _______ _______ _______ Less than 10 10-20 20-30 More than 30

My goal at the conclusion of this program is to _________ Finish a Half Marathon _________ Improve my Half Marathon time

What is your injury status at this time? _____ no injuries during the previous 8 weeks _____ missed some running time due to injury in last 8 weeks but OK now _____ still nursing an injury that presently affects my running If you answered choice 2 or 3 in the previous question, what is/was the injury? ______________________________________________________________________________ ______________________________________________________________________________ Has a physician or other healthcare provider ever told you that you should not participate in strenuous exercise for any reason? ____ Yes _____ No

If yes, please explain _____________________________________________________________ _______________________________________________________________________________

Waiver:
By submitting this form with your signature, you understand, agree, warrant and covenant as follows:
I, the person submitting this entry (and my child, if I am signing as a parent or guardian) agree to abide by the rules and decisions of any program officials, and assume all risks associated with the program and any associated LONGVIEW Running Club event or activities, including but not limited to falls, contact with other participants, encounters with animals, effects of the weather, traffic, road conditions, or health risks associated with known or unknown underlying disease, all such risks being known and appreciated. I (and my child, if I am signing as a parent or guardian) and anyone entitled to act on my (our) behalf(s), assume all risks associated with participation, and waive any and all claims, and fully release all organizers of, coaches of, sponsors of, and beneficiaries of this program, the Longview Running Club and all its officers and members, the City of Longview, AMBUCS, and all employees of aforementioned entities (referred to collectively as the "Released Parties"), from all claims, damages or liability of any kind arising from my (or my child's) participation in this program. I hereby release, waive, discharge, covenant not to sue, and agree to indemnify and hold harmless for any and all purposes the Released Parties from any and all liabilities, damages, claims, demands, or injuries, including death, that may be sustained by me resulting from or arising out of my participation in the Longview Running Club Half-Marathon Training Program, INCLUDING ANY SUCH DAMAGES, CLAIMS, DEMANDS, OR INJURIES, INCLUDING DEATH, CAUSED IN WHOLE OR IN PART BY THE NEGLIGENCE OR OTHER ACT OR OMISION OF THE RELEASED PARTIES, OR BY A PREEXISTING DEFECT. I understand that this agreement to indemnify and hold harmless does not apply to injuries caused by intentional or grossly neglected conduct. I grant full permission to any and all of the foregoing to use my (and my child's) name, or photographs, videos, and other recordings of participation in this event, without obligation or liability to me (and my child). I also understand that the training fee is not refundable. T-shirt size is not guaranteed. I have read this agreement carefully, and understand it, and certify my agreement by my signature below. I understand and agree that this Waiver and Release shall bind my heirs, assigns, successors, and personal representatives, including my spouse and members of my family, and shall be governed by the laws of the State of Texas.

Signature_____________________________________________________ Date_________________ Parent/Guardian Signature ______________________________________ Date_________________ (if participant is under age 18 on 01/04/2014) Mail to: Longview Running Club, PO Box 150555, Longview TX, 75615