Parent/Guardian's Name *

First Name

Last Name

Parent/Guardian's Date of Birth *

MM

DD

YYYY

Parent/Guardian's Phone Number *

(###)

###

####

What is the best way to reach you? *

Email

Phone

Relationship Verification *

You must be the parent or legal guardian to register someone between the ages of 14 and 17 (you cannot register anyone 13 years of age or younger). By registering a child between the ages of 14 and 17, you are consenting to the collection of the child's information that you are providing for the purposes of membership.

I hereby verify that I am the participant's parent or legal guardian.

Participant's Name *

First Name

Last Name

Participant's Gender *

Male

Female

Participant's Date of Birth *

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Waiver of Liability *

I agree that I am a participant in activities hosted by the West Georgia Track Club LTD, and I know that running in and volunteering for organized group runs, social events, and races with this club are potentially hazardous activities, which could cause injury or death. I will not participate in any club organized events, group training runs or social events, unless I am medically able and properly trained. I acknowledge my level of fitness and the risks involved in participation and by my signature, I certify that I am able to perform all activities associated with the club and am in good health. I agree to abide by all rules established by the club , including the right of any official to deny or suspend my participation for any reason whatsoever. I attest that I have read the rules of the club agree to abide by them. I assume all risks associated with being a member of this club and participating in club activities which may include: falls, contact with other participants, the effects of the weather, including high heat and/or humidity, traffic and the conditions of the road, and all such risks being known and appreciated by me. Having read this waiver and knowing these facts and in consideration of your accepting my membership, I, for myself and anyone entitled to act on my behalf, waive and release the West Georgia Track Club, the city of Carrollton, Georgia, and all club sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation with the club, even though that liability may arise out of negligence or carelessness on the part of the persons named in this waiver. I grant permission to all of the foregoing to use my photographs, motion pictures, recordings or any other record for any legitimate promotional purposes for the club.

By checking this box, I comply with West Georgia Track Club's Waiver of Liability.