Name *

First Name

Last Name

Phone *

(###)

###

####

Birthdate

MM

DD

YYYY

Which membership are you interested in? *

Endurance Essentials

Advanced Coaching

Emergency Contact Name *

First Name

Last Name

Emergency Contact Phone *

(###)

###

####

I know that physical exercise is a potentially hazardous activity. I should not participate in the running program unless I am medically able. I agree to abide by any decision of an official relative to my ability to safely complete the training program. I assume all risks associated with training, including but not limited to falls, the effects of weather, including high heat or humidity, all such risks being known and appreciated by me. Having read this waiver and knowing these facts, and in consideration of your acceptance of my application, I for myself, and anyone entitled to act on my behalf, waive and release On The Run Endurance Coaching, Robinson’s on the Run and Dusty Robinson, of any and all members thereof from all claims or liability of any kind arising out of my participation in the aforementioned training program. I consent to the use of my image in photos, videos and audio recording and film, of my participation in On The Run Endurance activities. *

I agree to the On The Run Endurance Waiver

By signing below I assert that I have read, understood, and agree to all of the documents I have selected above. Enter your name * *

First Name

Last Name

Parent or Legal Guardian Name

I agree to the On The Run Endurance Waiver on behalf of this registrant as the parent or legal guardian.

First Name

Last Name