ASA Athlete Application

Athlete's First Name

Athlete's Last Name

Athlete's Birth Date

Athlete's Gender

MaleFemale

Which of the following best represents the Athlete's racial or ethnic heritage?

Athlete's Height

Athlete's Weight

Parent/Guardian's First Name

Parent/Guardian's Last Name

Relationship to Athlete

Primary Phone Number - This is the phone number that will be used for all office communications, and emergencies

Secondary Phone Number

Primary Email Address This is the email address that all office communications, agreements, information will be sent to

Secondary Email Address

Address 1

Address 2

City

State

Zip Code

What is your preferred method of contact?

EmailPhone CallText

We're excited to get to know you, tell us more!

Please tell us a little about yourself? :) Family, activities, favorite things (movies, music, sports teams etc), other activities you're involved in.

Parent/Guardian Consent

PARTICIPATION, WAIVER, AND RELEASE AGREEMENT

PLEASE READ CAREFULLY BEFORE SIGNING,THIS IS A RELEASE OF LIABILITY

By providing my initials below I acknowledge my understanding that my participation in any Athletes Serving Athletes event and/or any pre- or post-event activities (collectively, the “Event”) involves rigorous physical activity and that it potentially may be hazardous. I attest and verify that my ability to participate in the Event has been verified by a licensed medical doctor. I expressly assume all known and unknown risks associated with the Event, including but not limited to: loss of or damage to my property; injury (including death); accidents; the effects of weather; and terrain conditions that may vary widely, and that may include uneven and/or slippery surfaces, spectators, participants, and natural and man-made obstacles (including without limitation, vehicles, security barriers, signs, cables, mats, and debris on the course). I assume all risks associated with being a member of ASA and participating in all ASA events, which may include but not limited to: falls, physical contact with other participants/members, volunteers, race personnel, contract service providers, employees, and spectators including the potential contraction of a communicable disease resulting from contact with other participants/members, volunteers, race personnel, contract service providers, employees, and spectators. I further agree to abide by the Center for Disease Control’s (CDC) recommendations for the prevention of the spread of the 2019 Novel Coronavirus Disease (COVID-19) and other communicable diseases, and I attest to having read the CDC’s guidance at: https://www.cdc.gov/coronavirus/2019-ncov/prepare/prevention.html. I will abide by all rules of ASA and I assume all such risks being known, appreciated, and accepted by me. In addition, I acknowledge the contagious nature of COVID-19 and other communicable diseases and voluntarily assume the risk that I may be exposed to or infected by COVID-19 and/or other communicable diseases by participating in any events associate with ASA. I acknowledge that such exposure or infection may result in personal injury, illness, permanent disability, and/or death. I understand that the risk of becoming exposed to or infected by COVID-19 in connection with my participation in any ASA events, and personally assume this risk.

In consideration of my participation in the Event, I, for myself, my heirs, executors, administrators, personal representatives, successors and assigns, waive any and all rights, claims and causes of action I have or may have against any Race Organizer that may arise as a result of my participation in the Event. For these purposes, a “Race Organizer” is any one or more of the following: Athletes Serving Athletes and their affiliates; all governmental agencies representing the territory in which the Event will be held; all sponsors, agents, vendors, and contractors of or for the Event; medical service providers; and the officers, directors, employees, representatives, successors and assigns of each of the foregoing. I hereby agree to indemnify all Race Organizers for all claims and losses (including attorney’s fees and court costs), which may be brought against any one or more of them by anyone claiming to have been injured or otherwise to have suffered loss or damage as a result of my participation in the Event.

I grant Athletes Serving Athletes permission to register me for races on my behalf. I further grant full permission to any and all of the foregoing to store, use and/or reproduce my image or likeness by any audio and/or visual recording technique (including electronic/digital) now in existence or hereafter invented, for any legitimate purpose, including commercial sales and marketing purposes. I understand and agree that information about me that is collected by Athletes Serving Athletes or the Race Organizers, including without limitation information on this form and my Event results may be disclosed to third parties for any legitimate purpose, including commercial sales and marketing purposes, and that it may be subject to re-disclosure by the recipient(s). I understand that ASA does not provide for refunds in the event of cancellations of services, and by signing this waiver, I consent that I am not entitled to a refund if any ASA activities including events are cancelled. I acknowledge and agree to abide by any Official Rules for the Event that may be posted at the Event or on the Event’s website. I hereby represent and warrant that I am 18 years of age or older or, if applicable, that I am the parent or legal guardian of the child under the age of 18 years old who I am registering for the Event and that I have the full power and authority to agree to these terms on behalf of such child, and to bind him/her to these terms.

I understand that failure to abide by ASA policies may result in expulsion from any and all future ASA events.

Please initial here to acknowledge that you have read, agree to, and accept this waiver.