Mercury Track Club
2009-2010
Mini Application
Last name: ________________________ First: ___________________________
Home address ___________________________City: ________________________
Home phone: __________________________ Mobile________________________
Email address: ______________________________
Club Membership Waiver: I, _______________________________________, know that running
and training are potentially hazardous activities. I should not enter and run in activities unless
I am medically able and properly trained. I assume all risks associated with running with
Mercury Track Club Program. The effects of the weather, including high heat and/or humidity,
I release Mercury Track Club Coaches for all such risks being known by me. Having read this waiver
and knowing these facts and in consideration of my application for membership, I , for myself
and anyone entitled to act on my behalf, waive and release Mercury Track Club, and all partners
and representatives and successors from all claims or liabilities of any kind arising out of my
participation.
HOLD HARMLESS STATEMENT In consideration for acceptance of my entry into the
Mercury Track Club Beginner Program. All coaches associated with this program, I release
and forever discharge all right and claim for damage which may hereafter accrue to me training
in the Mercury Track Club Conditioning and Core Program. The owner and operators of facilities
used for training purpose in which I participate, I release them of any and all damages which
maybe sustained or suffer by me while participating in the High performance Condition Program.
Signature: _________________________________ Date: _______________
Training Fees per month
2009-2010
Mini Application
Last name: ________________________ First: ___________________________
Home address ___________________________City: ________________________
Home phone: __________________________ Mobile________________________
Email address: ______________________________
Club Membership Waiver: I, _______________________________________, know that running
and training are potentially hazardous activities. I should not enter and run in activities unless
I am medically able and properly trained. I assume all risks associated with running with
Mercury Track Club Program. The effects of the weather, including high heat and/or humidity,
I release Mercury Track Club Coaches for all such risks being known by me. Having read this waiver
and knowing these facts and in consideration of my application for membership, I , for myself
and anyone entitled to act on my behalf, waive and release Mercury Track Club, and all partners
and representatives and successors from all claims or liabilities of any kind arising out of my
participation.
HOLD HARMLESS STATEMENT In consideration for acceptance of my entry into the
Mercury Track Club Beginner Program. All coaches associated with this program, I release
and forever discharge all right and claim for damage which may hereafter accrue to me training
in the Mercury Track Club Conditioning and Core Program. The owner and operators of facilities
used for training purpose in which I participate, I release them of any and all damages which
maybe sustained or suffer by me while participating in the High performance Condition Program.
Signature: _________________________________ Date: _______________
Training Fees per month
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We are schedule to have 14 to 16 practice days Per Month