Track Club Kilo Kids Waiver

Welcome to the Atlanta Track Club’s Kilometer Kids Program in conjunction with the Boys and Girls Club, YMCA, International Community School and Beloved Community, Inc. Based in your neighborhood, Kilometer Kids is a fun running program open to students ages 7 through 12 that promote fitness through running for youth. Sites meet twice a week, normally on Monday and Wednesday or Tuesday or Thursday. The goal is to promote fitness by making running fun and exciting. There are two midweek runs offered at Grant Park during the fall session. The first one is Wedensday, October 12 at 5:30 p.m. and the second one is Wednesday, November 2 at 5:30 p.m.

If you would like your child to participate in this fun fitness program, just fill out the form below. Have your child show up at their site on the designated practice days. Water and POWERade will be provided to each young runner. Parents are encouraged to come out and walk, run or volunteer. Please feel free to contact us at: 404-231-9064, extension 25 or email Tina at [email protected] regarding questions and/or comments.

Child’s Name (please print) Age/Date of Birth

Parent or legal guardian (please print)

Address Street number Street name Apt # Zip

Home phone #

Please note on form if your child has allergies to items such as: peanuts, oranges, etc., or medical: for example asthma (must have their own pump and know how to self- administer/use).

RELEASE FORM: In consideration of the Atlanta Track Club, Inc. (ATC) and any sponsors, agents, volunteers, or representatives conducting or supporting the Kilometer Kids Running Program and allowing my child to participate in this program, I agree not to sue any of the above named. I know that participating in a physical fitness program is a potentially hazardous activity. My child should not register to participate unless he or she is medically able. I agree to abide by any decision of a program director or volunteer relative to my child’s ability to participate. I assume all risks of my child’s participation in the Kilometer Kids Program including, but not limited to, falls, contact with other participants and program directors, effects of weather, any traffic or conditions of the venue surface. In consideration for your accepting my child’s registration I, for myself and my child, release the ATC, the City of Atlanta and Boys and Girls Club, YMCA, International Community School and Beloved Community Inc. and any sponsors from all claims and liabilities of any kind arising out of my child’s participation in this program. I grant permission from all named entities to use any photographs, motion pictures, recordings or any other record of this program for any legitimate purpose. I give permission for my child to attend the midweek fun runs at Grant Park in Atlanta, Ga. on October 12, 2011 and November 2, 2011. In the event of an accident, I authorize Atlanta Track Club to provide emergency medical treatment to my child as necessary. Signature of Parent or Legal Guardian required Date

Signature of Child (Both Signatures Required)