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Registration Form -
MiT Program
Name ______________________________________________________
Address ____________________________________________________
City __________________________ State _____
Zip ________________
Telephone _______________________
Email ______________________________________________________
Age ________ Date of Birth
___________ Gender: Male Female
Emergency contact name/number
____________________________________
Shirt size: S M L XL XX
Are you a walker? Yes No
Are you a beginner runner? Yes No
Or how long have you been running? __________
How many days/miles do you walk/run each week?
__________________
Have you ever run a marathon? Yes No
If so, how many, and what is your range of
finish times? _______________
Current MIT participant who referred you, if
any? _____________________
ALL PARTICIPANTS MUST READ
AND SIGN!
In consideration for the acceptance by Premier
Sports and Fleet Feet Sports of my application for entry to the
Marathoner in Training Program (the “Training Program”),
and other good and valuable consideration relating to the
Training Program, the sufficiency of which I hereby acknowledge,
I hereby agree as follows:
1. Acknowledgement. I acknowledge and agree
that Premier Sports and Fleet Feet Sports, their employees, independent
contractors, agents, representatives, volunteers and sponsors
cannot assure my safety during participation in the Marathoner
in Training Program. I acknowledge and agree that participation
in the Marathoner in Training Program exposes me to risks
including, but not limited to, running related injury, traffic
and the detrimental effects of heat and pollution.
2. RELEASE OF CLAIMS. I, FOR MYSELF, MY HEIRS,
EXECUTORS, ADMINISTRATORS, SUCCESSORS AND ASSIGNEES HEREBY
RELEASE, WAIVE AND FOREVER DISCHARGE AND HOLD HARMLESS PREMIER
SPORTS AND Fleet Feet Sports, THEIR EMPLOYEES, INDEPENDENT
CONTRACTORS, AGENTS, REPRESENTATIVES, VOLUNTEERS, SPONSORS,
SUCCESSORS AND ASSIGNS (“THE MiT PARTIES”) OF AND FROM ALL
CLAIMS, DEMANDS, DAMAGES, COSTS, EXPENSES, ACTIONS AND
CAUSES OF ACTION, WHETHER IN LAW OR EQUITY, IN RESPECT OF
DEATH, INJURY, LOSS OR DAMAGE TO MY PERSON OR PROPERTY,
HOWSOEVER CAUSED, ARISING OUT OF, BY REASON OF, OR DURING MY
ATTENDANCE AT OR PARTICIPATION IN THE TRAINING PROGRAM,
WHETHER AS A SPECTATOR, PARTICIPANT OR OTHERWISE (ALL OF THE
FOREGOING REFERRED TO HEREAFTER AS THE “CLAIMS”), WHETHER OR
NOT THE CLAIMS RESULT FROM MY FOLLOWING ANY PROGRAM OF DIET
AND/OR EXERCISE ON THE RECOMMENDATION OF ANY OF THE PREMIER
SPORTS OR Fleet Feet Sports
PARTIES, WHETHER SUCH CLAIM ARISES OUT OF EVENTS PRIOR TO,
DURING OR SUBSEQUENT TO SAID ATTENDANCE OR PARTICIPATION,
EVEN IF SUCH CLAIMS WERE CAUSED BY, CONTRIBUTED TO, OR OCCASIONED
BY THE NEGLIGENCE, FAULT OR OTHER CONDUCT OF THE PREMIER
SPORTS OR FLEET FEET SPORTS PARTIES.
Participant Signature __________________________________________
Date
Important:
All Participants in the
MiT Program must Read and Sign!
Certification Regarding Medical Condition
Anyone beginning an exercise program for the first time,
or restarting an exercise program after a period of inactivity,
must consult a doctor before starting the marathon training
program. Further, anyone who conforms to any of the following
criteria must consult a doctor before training and have
periodic check-ups throughout the marathon training program.
1. You are over age 60 and not accustomed to vigorous exercise
2. You have a family history of premature (i.e., under 55
years of age) coronary artery disease. 3. You frequently
have pains or pressure in the left- or mid-chest area, neck,
shoulder, or arm during or immediately after exercise. 4.
You often feel faint or have spells of severe dizziness,
or you experience extreme breathlessness after mild exertion.
5. Your doctor has said your blood pressure is too high
and is not under control, or you do not know if your blood
pressure is normal. 6. Your doctor has said you have heart
trouble, that you have a heart murmur, or that you have
had a heart attack. 7. Your doctor has said you have bone
or joint problems. 8. You have a medical condition not mentioned
here that might need special attention during an exercise
program (i.e., insulin-dependent diabetes, exercise-induced
asthma). By my signature I certify that I have read and
understand the above information. I have doctor’s approval,
or will consult with one before beginning the training program,
if the above information indicates that I should. Also,
I will inform my coach(es) of any medical conditions.
Signature __________________________________________________
Date
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