Renegade Runners
membership application ($20.00)

new____renew____                 NYRR#__________     MemID#__________
 
         
please print clearly in ink
   


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    last name                                                          first name

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    mailing address

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    city                                                      state                                    zip

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    home phone                    business phone                        cell phone

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   email address                                                   occupation

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   male      female                                                 age                                  birth date

WAIVER
As a member of the Renegade Runners, I agree to participate in races only for the Renegade Runners, and not be affiliated with any other running team.

When I take part in races or other organized athletic events I will abide by the rules set forth by the organizers of those events. This includes refraining from transferring race numbers to an unregistered runner or running with someone else's race number where that is prohibited. I understand that violation of this requirement is grounds for sanction by the Renegade Runners, up to and including my permanent dismissal from the team.

I acknowledge that training for and/or racing in a running event, walking event or other multi-sport can be an extreme test of a person’s physical and mental limits, is potentially hazardous, and carries with it the potential for injury or property loss. I hereby assume the risks of participating in all activities organized by the Renegade Runners or its members. I certify that I am physically fit and have not been advised otherwise by a qualified medical person.

I affirm that I have read this document and understand its contents. In consideration for your acceptance of this application to become a member of the Renegade Runners, a) I for myself and for anyone entitled to act on my behalf, waive, release, and discharge the Renegade Runners, its members, sponsors, officers, representatives and coaches from all claims or liabilities of any kind arising out of my participation in or traveling to and from an organized Renegade Runners activity; b) I agree not to sue any of the persons or entities mentioned above for any of the claims or liabilities that I have waived; and c) I indemnify and hold harmless the persons or entities mentioned above from any claims made or liabilities assessed against them as a result of my actions during an organized Renegade Runners activity even though that liability may arise out of negligence or carelessness on the part of the persons named in this waiver.


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signature                                                                    date

 
  make checks payable to:            Renegade Runners
                                                     114-64 Merrick Blvd
                                                     Jamaica, New York 11434

                                                     email: CoachDino@aol.com