SARNIA ROAD RUNNERS
Membership 2022
Name |
Sex |
Age on Mar.15 |
Date of Birth |
Shirt size (circle one) |
|
|
|
|
XS S M L XL |
|
|
|
|
XS S M L XL |
|
|
|
|
XS S M L XL |
|
|
|
|
XS S M L XL |
|
|
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|
XS S M L XL |
Runners will remain in the same age division for the entire season
Phone __________________ E mail
________________________________________________
Single membership $40
Family membership $50
Additional shirts $20
Do you give permission for a photograph of you to be posted on Facebook?
Yes __ No __
Signature ____________________________________________ Date
______________
RELEASE, WAIVER, AND
INDEMNITY AGREEMENT
In consideration of the acceptance of my application to
participate in and attend at Sarnia Road Runners’ Association (SRRA) events
and/or activities, “I, on behalf of myself, my heirs, executors,
administrators, successors and assigns, waive, release, and forever discharge
the Sarnia Road Runners’ Association, its officers, representatives, agents,
employees, members, organizers, officials, servants, and all participants,
competitors, and entrants from and against any and all kinds of actions,
claims, costs, and expenses and demands in respect of injury, death, loss or
damage, occurring prior to, during, or subsequent to SRRA events and/or
activities, to my person or property, howsoever caused and arising out of my
being permitted to attend at, or in any way take part in SRRA events and/or
activities, whether as a spectator, participant, competitor, entrant, or
otherwise, and notwithstanding that the same may have been contributed to or
occasioned by the negligence of any of the aforesaid. I further hereby undertake to hold and save
harmless and agree to indemnify all of the aforesaid from and against any and
all liability incurred by any or all of them arising as a result of, or in any
way connected with my participation in the said activity.”
I acknowledge having
read, understood, and agree to the above waiver, release, and
indemnification. I warrant that I am
physically fit to participate in Sarnia Road Runners’ Association events and/or
activities.
Signature
__________________________________________________ Date ___________________
Signature of Parent or
Guardian ________________________________________________ Date _______________
The
above parent/guardian (parent signing on behalf of family) consents to the
minor’s (family members under the age of 18) participation in Sarnia Road
Runners’ Association events and/or activities and acknowledge that he/she is
bound by the waiver to the same extent as minor(s).