2016/17BULLSEYE RUNNING HO COJUNIOR STRIDERSWINTER TRACKTEAM
This program is for sprintersage 7-18, born in 1999 through 2010.If a distance runner, email to discuss participation first. This program will start practicing 11/29/16 and eachTuesday and Wednesday evening from 6:15-7:15pm through 3/8/17outside under the lights (at least on Wed) on the Oakland Mills High track when weather permits (40 degrees or higher and no ice on track).Meetsare on Sunday’s onthe indoor track at the PG Complex,12/18, 1/8, 1/22, 1/29 and 2/12. AAU Nationals (3/10-12/17) are also an option! The cost of this program does not include the meet registration costs orAAU membership if needed. The cost of the program covers the organization and coaching at the practices and the meets and a uniform if needed (singlet/tank top/jersey, not shorts).Sorry, no refunds or make ups if weather cancels practice.CONTACT HEAD COACH, COACH LINCOLN, AT WITH ANY QUESTIONS!
This program is separate from the Winter Indoor Running Program with the Rec & Parks Program that we have on Saturday evenings at the Meadowbrook Facility. If you also want to do that program you need to sign up separately for that with the Rec & Parks, go to the web site, for the link to do that, that program starts on 1/14/17. You can do both, Coach Lincoln is !
Please complete this registration form and mail it to Coach Lang, 5412 Thunder Hill Rd, Columbia, MD 21045 with $95 cash or check made payable to Bullseye Running.
One registration form for each runner - Shirt size: (circle one)Youth or Adult, (circle one) Extra Small, Small, Medium or Large
First and LastName:______, Birthdate (m/d/y): ______, Gender: Male or Female
StreetAddress:______,City:______,State:______,Zip:______
Mom’s cell #:(______)______,Dad’s cell#:(_____)______
One Parent’s Email:______Mother and Father'sFirst and Last Name:______
Waiver/Release: I, the undersigned, am the parent or legal guardian of the minor whose name appears above. I know that running is a potentially hazardous activity. I know that the minor should not run unless medically able and properly trained. I agree to abide by any decision of the program director relative to the minor’s ability to safely complete the risks associated with running in this program including, but not limited to: falls, contact with other participants,the effects of the weather, including high heat and/or humidity, traffic and other conditions of the road, track or trails, all such risks being known and appreciated by me. Having read this waiver and knowing these facts, I, for myself, on behalf of the minor, my heirs, personal representatives and assigns do hereby release, waive, dischargeand covenant not to sue the Howard County Striders, Coach Lang, LLC/Bullseye Running, the Road Runners Club of America, USA Track & Field, the AAU, the Facility and Sponsors, their respective officers, directors, agents, employees, volunteers and successors (collectively “Releasees”) from all liability, loss, claims, demands, possible causes of action, court costs, settlement costs and fees, attorney’s fees and any other expenses arising out of the minor’s participation in this event/program even though that liability may arise out of negligence or carelessness on the part of the persons named in this waiver. I further authorize and empower the program director or appointed volunteer to consent to and authorize any medical care and treatment for the minor that may appear reasonably necessary as a result of emergency, accident or illness of the minor whether occurring before, during or after the event/program. Further, I granta limited license to allof thepersons named in this waiver to use the participants name, likeness, image, voice, video, athletic performance, biographical and other information, in any format whatsoever, and to distribute, broadcast and exhibit these without charge, restriction or liability, but only for the purposes of advertising or promoting the sport of Athletics or other legitimate purposes. I understandthat bicycles, skateboards, baby joggers, roller skates orblades, animals, and personal music players are not allowed for use in this event/program and I will ensure that the minor abides by this guideline.
SignatureofParent/Guardian______Date______
Pay with cash or make check payable to Bullseye Running, mail toCoach Lang, 5412 Thunder Hill Road, Columbia, MD 21045.
NEW SAFETY NOTICE REQUIRED FOR ALL ATHLETES AND PARENTS TO READ AND SIGN
Concussion Information Sheet
A concussion is a brain injury and all brain injuries are serious. They are caused by a bump, blow, or jolt to the head, or by a blow to another part of the body with the force transmitted to the head. They can range from mild to severe and can disrupt the way the brain normally works. Even though most concussions are mild, all concussions are potentially serious and may result in complications including prolonged brain damage and death if not recognized and managed properly. In other words, even a “ding” or a bump on the head can be serious. You can’t see a concussion and most sports concussions occur without loss of consciousness. Signs and symptoms of concussion may show up right after the injury or can take hours or days to fully appear. If your athlete reports any symptoms of concussion, or if you notice the symptoms or signs of concussion yourself, seek medical attention right away.
Symptoms may include one or more of the following: Adapted from the CDC and the 3rd International Conference on Concussion in Sport Document created 6/15/2009; adapted 1/13/2010
Headaches; “Pressure in head”; Nausea or vomiting; Neck pain; Balance problems or dizziness; Blurred, double, or fuzzy vision; Sensitivity to light or noise; Feeling sluggish or slowed down; Feeling foggy or groggy; Drowsiness; Change in sleep patterns; Amnesia; “Don’t feel right”; Fatigue or low energy; Sadness; Nervousness or anxiety; Irritability; More emotional; Confusion; Concentration or memory problems (forgetting game plays); Repeating the same question/ comment.
Signs observed by teammates, parents and coaches include:
Appears dazed; Vacant facial expression; Confused about assignment; Forgets plays; Is unsure of game, score, or opponent; Moves clumsily or displays incoordination; Answers questions slowly; Slurred speech; Shows behavior or personality changes; Can’t recall events prior to hit; Can’t recall events after hit; Seizures or convulsions; Any change in typical behavior or personality; Loses consciousness.
Concussion Information Sheet
What can happen if my child keeps on playing with a concussion or returns to soon?
Athletes with the signs and symptoms of concussion should be removed from play immediately. Continuing to play with the signs and symptoms of a concussion leaves the young athlete especially vulnerable to greater injury. There is an increased risk of significant damage from a concussion for a period of time after that concussion occurs, particularly if the athlete suffers another concussion before completely recovering from the first one. This can lead to prolonged recovery, or even to severe brain swelling (second impact syndrome) with devastating and even fatal consequences. It is well known that adolescent or teenage athletes will often under report symptoms of injuries, and concussions are no different. As a result, education of administrators, coaches, parents and students is the key for student-athlete’s safety.
If you think your child has suffered a concussion
Any athlete even suspected of suffering a concussion should be removed from the game or practice immediately. No athlete may return to activity after an apparent head injury or concussion, regardless of how mild it seems or how quickly symptoms clear, without medical clearance. Close observation of the athlete should continue for several hours. You should also inform your child’s coach if you think that your child may have a concussion. Remember it’s better to miss one game than miss the whole season. And when in doubt, the athlete sits out.
For current and up-to-date information on concussions you can go to:
Athlete Name PrintedAthlete SignatureDate
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Parent or Legal Guardian Printed Parent or Legal Guardian Signature Date
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