Heart of the Valley Runners

Membership Application

Last Name: First Name:
Address:
City: State: Zip Code:
Email:
Primary phone: Alt phone:
Birth Date:
Gender:Male Female

Membership Type:Individual $20 Family $30 Student $10

Middle School Cross Country Participant:Cross Country

School:

I'd like information on volunteering with the club:I'd like to help out!

Please enter name and birthdate (including year) and gender of each family member.
If desired, include additional email addresses too.
All family members must reside at the same address.

Family Member 1 Name: Birth Date: Gender: Email:
Family Member 2 Name: Birth Date: Gender: Email:
Family Member 3 Name: Birth Date: Gender: Email:
Family Member 4 Name: Birth Date: Gender: Email:
Family Member 5 Name: Birth Date: Gender: Email:
Family Member 6 Name: Birth Date: Gender: Email:

I understand that participating in club events (including running and/or volunteering in club races) is potentially hazardous and I assume all risks associated with this, including but not limited to traveling to and from events, falls, contacts with other participants, the effects of weather, including high heat and/or humidity, the conditions of the road or track and traffic on the race course, all such risks being known and understood by me. I should not enter and run in club races unless I am medically able and properly trained and I agree to abide by any decision of a race official relative to my ability to safely complete the run. Having read this waiver and knowing these facts, and in consideration of your acceptance of my application for membership, I, for myself and anyone entitled to act on my behalf, waive and release the Road Runners Club of America, Heart of the Valley Runners and all sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation in all club events even though that liability may arise out of negligence or carelessness on the part of the person named in this waiver. In addition, I grant permission to all of the foregoing to use my photographs, motion pictures, recordings, or any other record of club events for any legitimate purposes. By submitting this application I certify that I have read and agree to the above terms.

Questions? Comments? Type them here!