Friends & Fitness Runners Training Program

Please check back January 2009 for information on next year’s program. Thank you!

Before proceeding, please read and agree with our terms below. For assistance, please email Craig Mastrangelo, Program Director, at craig@neighborhoodhome.com.

Name:*
Address:*
Cell Number:*
Email Address (for program updates):*
Date of Birth (xx/xx/xxxx):*
Emergency Contact:*
Emergency Number:*
Referred by:
Shirt Size:*	S M L XL
	RELEASE AND WAIVER OF LIABILITY AGREEMENT ALL PARTICIPANTS IN THE FRIENDS & FITNESS RUNNERS TRAINING PROGRAM (“RUNNING PROGRAM”) ARE REQUIRED TO, AND HEREBY DO ASSUME ALL RISK OF PARTICIPATION IN THE RUNNING PROGRAM BY SIGNING THIS GENERAL RELEASE AGREEMENT. The undersigned runner (“Runner”) on behalf of himself/herself and on behalf of the Runner’s personal representatives, assigns, heirs, executors, and successors hereby fully and forever releases, waives, discharges and covenants not to sue Friends & Fitness, Craig Mastrangelo, Arlington County, Falls Church City, Fairfax County, Alexandria City, Vantage Fitness, George C Marshall High School and Yorktown High School and/or ANY municipal agencies whose property and/or personnel are used or in any way assist, all sponsoring or co-sponsoring companies or individuals related to the Running Program, together with their officers, directors, shareholders, successors and assigns, (collectively “Releases”) from all liability to the Runner and his/her personal representatives, assigns, heirs, executors, and successors for any and all loss(es), damages(s) and any and all claims or demands therefore, or otherwise, in connection with Runner’s participation in the Running Program. Runner represents and warrants that he/she is in good physical condition and is able to safely participate in the Running Program. Runner is fully aware of the risks and hazards inherent in participating in the Running Program and hereby elects to voluntarily participate, knowing the risks associated with the Running Program. Runner hereby assumes all risks of loss(es), damage(s), or injury(ies) that may be sustained by him/her while participating in the Running Program. Runner agrees to the use of his/her name and photograph in broadcasts, newspapers, brochures and other media without compensation. Runner acknowledges that the program fee paid is non-refundable and non-transferable. Runner acknowledges and agrees that Friends & Fitness, in its sole discretion, may delay or cancel any group runs/workouts if it believes the conditions on a particular day are unsafe. The Runner hereby grants to Craig S. Mastrangelo, Program Director, and his/her agents, affiliates and designees, access to all medical records (and physicians) as needed and authorizes medical treatment as needed. Runner understands that they have the right to refuse medical care and advice of Running Program directors and representatives; if Runners’s medical condition becomes such that the Runner’s mental capacity is questioned, the Program Director has the right to recommend and initiate treatment of Runner. It is understood and agreed that Runner hereby assumes liability for any and all medical expenses incurred as a result of training for and/or participation in the Running Program, including but not limited to ambulance transport, hospital stays, physician and pharmaceutical goods and services. It is understood and agreed that Runner hereby assumes liability for the risks associated with running, including, but not limited to, stress fractures, heat exhaustion, heat stroke, muscle cramps, muscle pulls, muscle tears, shin splints, knee pain, sprains/strains, dehydration, and even death. Runner agrees to consult with a physician prior to starting this program to determine whether Runner is physically capable of participating in this running program. Runner agrees to consult with a physician regarding any medications Runner may be taking that may adversely affect Runner’s health by participating in the Running Program. Runner agrees to consult with a physician if Runners has any questions regarding personal body ailments/limitations that may be aggravated/worsened by Runner participating in Running Program. Runner warrants that all statements made herein are true and correct and understands that Releasees have relied on them in allowing Runner to participate in Running Program. RUNNER HAS READ THE FOREGOING AND INTENTIONALLY AND VOLUNTARILY SIGNS THIS RELEASE AND WAIVER OF LIABILITY AGREEMENT. IF RUNNER IS UNDER AGE 18 HIS/HER PARENT OR GUARDIAN MUST SIGN THIS RELEASE AND WAIVER AGREEMENT. Runner’s Parent or Guardian’s signature above certifies that my son/daughter/ward has my permission to participate in the Running Program. Runner’s Parent/Guardian has read and understands the foregoing RELEASE OF WAIVER OF LIABILITY AGREEMENT (above) and by signing intentionally and voluntarily agrees to its terms and conditions. Runner’s Parent/Guardian further certifies that my son/daughter/ward is in good physical condition and is able to safely participate in the Running Program. I hereby authorize medical treatment for him/her and grant access to my child’s medical records as necessary and as stated above. Printable Version
	I Agree to the Release of Liability statement

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