Paradise Running Club Membership Form

PARADISE RUNNING CLUB MEMBERSHIP FORM

Name:______Herein after “Member/Guardian” (Persons under the age of majority (19 years) will require a guardian to sign on their behalf.)

Mailing Address:______

Phone:(H)______(Other)______

Date of Birth:______Male_____ Female_____

Email Address:______

Release and Waiver(please read carefully)

I, the Member/Guardian am fully informed and aware that running and participating in club activities are potentially hazardous. I understand I should not participate in club activities unless I am medically fit and able to safely participate. I acknowledge it is my sole responsibility to ensure my level ofmedical fitness and do hereby declare that I am medically fit.I assume all risks associated with all club activities including, but not limited to, personal injury, falls, contact with other participants/obstacles, the effects of the weather, such as heat and/or humidity, cold/ ice and snow, the conditions of the road/trails and traffic on the course, all such risks being known and appreciated by me.

I , the Member/Guardian acknowledge having read and understood this waiver In consideration of the acceptance of my application for registration as a member of the Paradise Running Club (PRC), I, for myself, my heirs, executors, administrators, successors and assigns HEREBY RELEASE, WAIVE AND FOREVER DISCHARGE the PRC and its respective agents, officials, employees, volunteers, contractors, representatives, successors and assigns of and from all claims, demands, damages, costs, expenses, actions and causes of action, whether in law or equity, in respect to death, injury, loss or damage to my person or property HOWSOEVER CAUSED, arising or to arise by reason of my registration as a member of the PRC or my participation in any PRC sponsored and/or sanctioned event, whether prior to, during or subsequent to any such event AND NOTWITHSTANDING that same may have been contributed to or occasioned by NEGLIGENCE of any of the aforesaid. IF THIS WAIVER IS ALTERED THE REGISTRATION WILL BE REJECTED.

PHOTO RELEASE - I hereby grant the PRC permission to use my image in good taste in promotional materials, posters, Web sites and other merchandise. I release PRC from all liability of any nature in the use of any electronic or film image and or audio for advertising purposes.

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Signature of ApplicantDate

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Signature of Parent or GuardianDate

Select One

Competitive Membership Annual Fee: $50.00 (January 1st-December 31st), which includes the $25.00 NLAA individual competitive membership fee.

Family Competitive Membership Annual Fee: $25.00 per person + $65.00 (January 1st-December 31st) which includes the $65.00 NLAA Family competitive membership fee.

Non-Competitive Membership Fee: $26.00/ year (January 1st-December 31st), which includes the $1.00 NLAA individual non-competitive membership fee.

Please see NLAA.ca for AllNLAA Membership Option Details.

Please complete this form and make cheque payable to: Paradise Running Club