Rustburg, VA – Sign Up Form

In consideration of this application being accepted, I certify that I am the parent or legal guardian of the above named participant (“Minor”), a minor, and hereby consent to his/her participation in the Crazy Running program. I hereby waive and release any and all claims that I may have, or that my child may have, against Willpower Athletes LLC (an independently owned and operated franchisee of Crazy Running Franchising LLC), Will Triplett, Jessica Cowart, Donald Cowart and any other coaches or staff (“Releasees”) from any and all liability, claim, judgment, loss, costs and expenses arising out of any illness or injury that my child or I may incur or sustain during the program. I have had the opportunity to inspect the premises used for practices and am satisfied with its condition. I understand that, in the event of an injury or illness of my child, a representative of Willpower Athletes LLC will try to notify me or another emergency contact first. In the event that I or another emergency contact cannot be reached, I authorize Willpower Athletes LLC to obtain necessary medical treatment for Minor and hereby, in my own behalf, release and hold harmless Releasees in the exercise of this authority. I also accept full financial responsibility for such care. I acknowledge that the Minor suffers from the following conditions that may be important for the Crazy Running coaches to be aware of: