This information contained in this medical history form will only be used by the Palmetto Road Runners Organization Board and Coaches for purposes of determining if you pose a health threat/ risk to yourself on the athletic field. This information will remain CONFIDENTIAL at all times.

I hereby certify that the information provided is accurate to the best of my knowledge. I understand that this medical authorization may be voided in the event of a injury, illness, or accident and that I may not be cleared for participation at such time. I hereby acknowledge that it is my responsibility as the athlete or parent/ guardian to inform my coach or organization official in writing if there are any changes to my medical condition. I also understand that it is my responsibility to obtain written permission from my physician on official medical conditions to seek permission to participate.

Image Release

In consideration of participation in the Palmetto Road Runners Track & Field Organization, the undersigned agrees that their likeness, or the likeness of their child/ward may be photographed or videotaped and that such image may be published in an outlet used to promote or publicize the sports program.

Palmetto Road Runners Track & Field Liability Waiver

Liability Waiver

I hereby state that Palmetto Road Runners is not responsible for any pre-existing injury or reoccurrence of any pre-existing injury or illness of the participating athlete. Participating athlete must have a valid physical before participating athlete can compete. Palmetto Road Runners is not responsible for any injury obtained while participating athlete is in competition. I release Palmetto Road Runners form all Competition Liability.

*Competition Liability includes Competition meet day, practice, and conditioning.

In order to complete the athlete's registration, the following documentation must be provided.

*Physical

*Registration packet

*AAU Registration (wait for the club code before signing up)

*Membership Fees +