Dear Families,

 

Welcome to the Teens Run DC community! Please complete this online enrollment form so that your child may participate in Teens Run DC’s sports-based youth development program!

 

What is Teens Run DC?

Teens Run DC uses physical activity and mentoring to develop life skills in middle and high school students. The program is free and open to youth of all fitness levels and abilities.

 

Weekday School Program

  • Youth participate in fitness & life skills sessions with TRDC coaches and school staff.
  • Youth attend at least 3 weekend races throughout the year.
  • Program is available to youth at specific TRDC partner school sites.

 

Weekend Mentoring Program

  • Youth attend running practice on Saturday mornings and run races throughout the year.
  • Youth are paired with trained mentors who have undergone background checks.
  • Program is available to all DC area youth. Families are also welcomed to attend practices and events!

 

Questions?

  • Contact Associate Program Manager Alee Wade at 202-818-8600 ext. 2 or alee@teensrundc.org. For the School Program, you may also contact the TRDC coach at your child's school or program site.
  • Visit our website at www.teensrundc.org. Check out our calendar for information on upcoming programs and events.

 

Enrollment Checklist

In order for your child to participate in Teens Run DC programming, please complete this online enrollment form in its entirety. The enrollment form is broken into the following three sections:

  • Youth Enrollment Form (Youth Information, Parent Information, & Emergency Treatment Information)
  • Waiver of Liability (Parent/Guardian signature required)

YOUTH ENROLLMENT FORM

Youth Information

School- Other
Date of Birth (MM/DD/YYYY)*
Ethnicity (Other)
Primary Language
Country*
State / Province*
Address*
City*
*
*
*
*
*
*
Youth's Email*
Confirm Email*
Youth's Phone #*

Parent/Guardian Information

Parent/Legal Guardian Name (First & Last)*
If "other", please indicate relationship of legal guardian to student
Parent/Legal Guardian Street Address*
Parent/Legal Guardian Zip Code*
Parent/Legal Guardian Primary Phone*
Parent/Legal Guardian Cell/Alternate Phone*
Parent/Legal Guardian Email*

Emergency Treatment & Medical Information

Emergency Contact Name*
Emergency Contact Relationship to Youth*
Emergency Contact Phone*
Youth's Allergies/Medical Conditions (physical & mental health; if none, please enter "N/A")*
Youth's Medications (If none, please enter "N/A")*
Insurance Company
Insurance Policy #
Policy Holder's Name

RELEASE OF LIABILITY, WAIVER OF CLAIM & ASSUMPTION OF RISKS AGREEMENT

(This document affects your legal rights and the rights of your child. By signing this document, you will waive certain legal rights, including the right to sue or claim compensation following an accident, injury or death.  You must read and understand it before signing it).

 

Acknowledgment of Relationship:  I hereby certify that I am the parent or legal guardian of the minor child listed in this enrollment packet (my “Child”).

 

Permission to Participate, Including Transportation and Race Entries: I hereby voluntarily grant permission for my Child to participate in all activities conducted by Teens Run DC (“TRDC”), including TRDC activities at TRDC program sites and field trips and activities away from TRDC program sites. This permission extends to transportation to any such activities and events. I give permission to TRDC to register my Child for TRDC races and events and sign as guardian for my Child on the entry form of TRDC races and events.

 

Evaluation Consent: I give permission to TRDC to collect and record data, including running/walking pace data and surveys, about my child with the understanding that all information obtained will remain private, and that any responses publicly reported will be grouped together with other participants of this program and that my child will not be individually linked to his/her response. Only the staff approved by TRDC will be able to view his/her responses.

 

Understanding of Activities and Medical Certification: I, the undersigned participant, acknowledge and grant permission for my Child to participate in the TRDC Program. I certify that my Child is medically and physically fit to participate in TRDC, and has not been advised otherwise by any person (including any medical personnel). My Child is in good health and has no medical or other physical condition or impediment that would endanger him/her if he/she participates in any TRDC activities. I further acknowledge and understand that TRDC strongly recommends that he/she get a physical from a health care provider prior to participation in the program.

 

Assumption of Risks: I, on my own behalf, on behalf of my Child and on behalf of anyone authorized to act on behalf of my Child, understand and acknowledge the risks of injury to my Child from the TRDC program and from the transportation associated with the program, that running is a potentially hazardous activity and that potential risks include, but are not limited to, falls, contact with other participants, the effects of weather, including high heat and/or humidity, the conditions of the road and traffic on the course, all such risks being known and appreciated by me.  I understand, acknowledge and agree that my Child should not enter or run in these activities unless he/she is medically able and properly trained. I, on my own behalf, on behalf of my Child, and on behalf of anyone authorized to act on behalf of my Child, agree to abide by any decision of a race official relative to his/her ability to safely complete the run. I further understand and acknowledge the risk of accident serious injuries and death from the transportation to be provided through TRDC. I, on my own behalf, on behalf of my Child and on behalf of anyone authorized to act on behalf of my Child, understand, acknowledge and voluntarily assume all risks associated this Program, both known and unknown, identified or unidentified, anticipated or unanticipated, even if arising from the negligence of any Teens Run DC or its agents, employees, members, managers, officers, directors, all volunteers, sponsors, organizers, independent contractors, affiliates, predecessors, successors, and any promoting organization(s), medical providers, property owners, law enforcement agencies, all public entities, special districts, and properties (and their respective shareholders, agents, officials and employees) or others, and I assume full responsibility for my Child’s participation.

 

Release of Liability/Waiver of Claims:  As lawful consideration of my Child’s acceptance into the TRDC program and the right to engage as a participant in any way in TRDC programs, related events and activities, I, on my own behalf, on behalf of my Child, and on behalf of anyone entitled to act on my Child’s behalf, acknowledge, agree and promise that I will not make a claim of any kind, including but not limited to a claim for personal injury, property damage and/or wrongful death, against TRDC, DCPS, its agents, employees, members, managers, officers, directors, all volunteers, sponsors, organizers, independent contractors, affiliates, predecessors, successors, and any promoting organization(s), medical providers, property owners, law enforcement agencies, all public entities, special districts, and properties (and their respective shareholders, agents, officials and employees) (collectively, the “RELEASEES”) through or by which the programs, related events and activities occur. 

 

This agreement is intended to discharge in advance RELEASEES from and against any and all liability asserted by me individually and on behalf of my Child, our heirs, assigns, legal representatives, executors, administrators, successors in interest, estate and next of kin (hereinafter collectively our “Successors”), including liability for negligence arising out of, or connected in any way, with my Child’s participation in the Teens Run DC.  I further agree to indemnify and hold harmless RELEASEES from any liability, claim, or action for personal injury, property damage, wrongful death which arises out of or related to participation in the program, whether or not the liability, claim, or action, arises out of the negligence and carelessness on the part of RELEASEES.

 

Consent to Medical Treatment: In the event of a medical necessity or emergency, I hereby authorize the adult representative of Teens Run DC and/or TRDC’s partners, including DCPS, to make any necessary arrangements for the proper medical or surgical care of my Child, and to give the required consents in connection therewith. I further authorize any medical, dental, and/or emergency personnel selected by such adult representative to secure and provide necessary and proper medical treatment my Child. I also give consent for my child to be transported by ambulance to an emergency center for treatment. I understand that I will be notified as soon as possible in the event an emergency arises requiring medical assistance, and I assume all financial responsibility for any medical treatment (including transportation) for my Child.

 

Media Release: I give consent for my Child to be photographed, audio recorded, or video recorded as part of TRDC. I give permission for these photographs, audio recordings, and videos to be used in non-commercial radio, television, internet, or print media reports and/or media campaign(s) resulting from participation in the program and its activities, including annual reports, newsletters, brochures, and/or other media outlets. I understand that my Child and I will receive no compensation for his or her appearance in these non-commercial media campaigns. I further agree that TRDC partners and the sponsors of any TRDC event may use my Child’s name and likeness for publicity purposes.

 

Entire Agreement:  I agree, for myself, my Child and our Successors, that the above representations are contractually binding, and this RELEASE OF LIABILITY, WAIVER OF CLAIM AND ASSUMPTION OF RISKS AGREEMENT may not be modified orally.  I agree that this agreement will be governed by the laws of the District of Columbia.  I understand that this is the entire agreement between TRDC and me and that it is for the benefit of all Releasees. My signature below indicates that I have read this entire document, understand it completely, and agree to be bound by its terms.

 

AcknowledgmentI have carefully read and understand the terms of this Release of Liability, Waiver of claims and Assumption of Risks Agreement.  I understand that this is a legally binding document and that I am giving up substantial legal rights by signing this Release of Liability, Waiver of claims and Assumption of Risks Agreement, and I sign it freely and voluntarily without any inducement or anyone forcing me to participate in the Teens Run DC Programs and Activities.

 

I/we, legal parent/guardian(s) of the minor child listed in this enrollment packet agree to the terms listed in the above agreement and hereby certify that the statements in this enrollment form are correct and true.

Parent/Legal Guardian Electronic Signature*
Waiver of Liability Signature Date (MM/DD/YYYY)*

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