Agility Training Registration

Parent/Guardian Name

Phone

Athlete's First Name

Athlete's Last Name

Athlete's Birthday

Month

Day

Year

Athlete's Age

Athlete's Grade

Athlete's Gender

Male

Female

Athlete's School

Teacher

Medical Information for Athelete

List any allergies or medical conditions

Is the athlete prescribed an inhaler?

Yes

Emergency Contact

Phone

Relationship

Hart2Hart Running Club Liability Waiver and Release of Claim

I give permission for my child to participate in the selected Hart2Hart Running Club activities. I understand that participation involves risk and I assume all responsibility for those risks. I release and hold harmless Hart2Hart Running Club, its officers, and representatives from any liability for injuries that may occur while traveling to,participating in,or returning from club activities.

In the event of injury, I waive all claims against Hart2Hart Running Club, its coaches, affiliates, participants, sponsors, advertisers, and property owners. I understand that sports participation involves inherent risks, including serious injury such as fractures, paralysis, or death.

Photography & Media Release: I grant H2H Running Club permission to photograph, record, and use images or video of my/my child’s participation in club activities for promotional purposes, including social media,websites,and marketing materials. I understand that no compensation will be provided and I waive any ownership rights to such media. If I do not consent, I will notify the club in writing.

By checking this box, I acknowledge that I have read and agree to the Hart2Hart Running Club Liability Waiver, Release of Liability, and Assumption of Risk.

Registration Fee

$100