SLDC YOUTH PROGRAM
MEMBERSHIP APPLICATION
Individual Application Form*
The San Luis Distance Club was formed in 1974 by a group of local residents to promote distance running in San Luis Obispo County. The activities of the Club include the sponsorship of races within the County, the fielding of teams at various levels of competition, conducting group track and distance workouts, and help supporting a youth program dedicated to introducing cross country and track and field for youth ages 11 through 14.
Members receive a monthly Club newsletter and information about upcoming central coast events, news and race results for the term of the youth cross country and track seasons.
NOTE: This form is free text in which you may type information from your keyboard into the appropriate input boxes. When finished, you have the option of printing this page from the 'printer icon' on your browser tool bar.
Youth Name: Age: Grade: Birth Date:
Youth Name: Age: Grade: Birth Date:
Youth Name: Age: Grade: Birth Date:
Address: City/Zip:
Home Phone: Work Phone: Ext:
Cell Phone #1: Cell Phone #2:
E-Mail Address#1: E-Mail Address#2:
Prior 'Roo Rat Seasons or Races Attended:
1.
2.
3.
Other Information:
Medical Conditions:
Allergies:
Other Sports:
Checks Payable to: SLDC - ROO RATS
WAIVER: I know that running and volunteering to work at Club and/or Youth races are potentially hazardous activities. I should not enter and run in Club and/or Youth activities unless I am medically able and properly trained. I agree to abide by any decision of a race official relative to my ability to safely complete an event. I assume all risks associated with running and volunteering to work in Club races including but not limited to falls, contact with other participants, the effects of weather (including high heat and humidity), the conditions of the road and traffic on the course, all such risks being known and appreciated by me. Having read this waiver and knowing these facts, and in consideration of acceptance of my application for membership, I, for myself and anyone entitled to act on my behalf, waive and release the Road Runners Club of America, the San Luis Distance Club, and their sponsors, their representatives, and their successors from all claims and liabilities of any kind rising out of my participation in Club and/or Youth activites even though that liability may arise out of carelessness or negligence on the part of persons named in this waiver.
ATHLETE SIGNATURE: _______________________________________________________
SIGNATURE: ________________________________________________________________ DATE:
*(Parent's or guardians signature required if participant is under 18 years of age)
