Insert the name of your emergency contact person

Insert the phone number of your emergency contact.

Please list any allergies and/or medical conditions.

In consideration of being allowed to participate in any way in the Fleet Feet Training Program, Streakers, Road Runners, No Boundaries, and/or WalkSTRONG its related events and activities, I, the undersigned, acknowledge, appreciate, and agree that: The risk of injury from the activities involved in this program is significant, and while particular skills, equipment, and personal discipline may reduce this risk, the risk of serious injury or death does exist. I knowingly and freely assume all such risks, both known and unknown, even if arising from the negligence of the releases or others, and assume full responsibility for my participation; and, I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the Company immediately; and, I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, hereby release, indemnify, and hold harmless the Streakers, Road Runners, No Boundaries, and/or WalkSTRONG, FLEET FEET SPORTS GREENSBORO & HIGH POINT, employees, coaches, volunteers, officers, directors, successors and assigns, the City of Greensboro, the City of High Point and any and all sponsors, their representatives and successors, with respect to any and all injury, disability, death, or loss or damage to person or property associated with my presence or participation, whether arising from the negligence of the releases or otherwise, to the fullest extent permitted by law. I attest that I am in good health and physically capable of participating in the Fleet Feet Training Program, Streakers, Road Runners, No Boundaries, and/or WalkSTRONG and my medical care provider has approved my participation. Further, I hereby release, consent to, and authorize, in advance, any such use of my name, photograph, voice or likeness by the foregoing parties in any manner they deem appropriate and necessary without remuneration to me. Fruthermore, any photograph, video, or other likeness that I post to any Fleet Feet affliated facebook or other social media, I hereby hereby release, give consent to, and authorize Fleet Feet Greensboro and High Point the right to use such media for their own commericial purposes and without any remuneration to me. Any dispute about this waiver and release should be governed by the laws of North Carolina. I HAVE CAREFULLY READ THIS WAIVER AND RELEASE AND FULLY UNDERSTAND ITS CONTENTS.