Athlete's Name *

Print Full Name as it appears on birth certificate. If you go by a name other than your first name, please write it in parenthesis.

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Best Phone Number to Contact *

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Guardian One's Name *

First Name

Last Name

Guardian One's Phone *

(###)

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Guardian Two's Name

First Name

Last Name

Guardian Two's Phone

(###)

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Emergency Contact Phone *

(###)

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Physician's Phone *

(###)

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Liability Waiver *

Additional waiver will be provided before XC season to address updates with COVID and training areas. I agree that the athlete and I will abide by the rules of the Park City Running Club. I also certify that the above named player is in good health to participate in the sports of Cross Country and/or Track & Field. I understand that the above named athlete will participate for the Park City Running Club at his or her own risk and will assume all liability in the case of injury. Furthermore, I release the Park City Running Club any representatives of the Park City Running Club, and the owners and representatives of the practice and competition venues of any risks, hazards and claims incidental to my child’s participation. I also give my consent for emergency medical care prescribed by a duly licensed Doctor of Medicine or Doctor of Dentistry. This care may be given under whatever conditions are necessary to preserve life, limb and well being of my dependent.

I Agree