Application Registration Form Name* First Last Address* Street Address City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Date Of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Email* Enter Email Confirm Email Phone*Emergency Name* First Last Emergency Phone*Event Category* Male Category Female Category Practice Shirt Type* Male Female Practice Shirt Size* AS AM AL AXL In what events do you compete?What are your top 3 performances in the past five years?What are your running goals for the next few years?Are you interested in competitive training or personal training?Please list any competitive running or track clubs or teams of which you have been a member.Is there anything else you would like SI Elite Track & Field Club to know about you?Waiver* I agree to this waiver.In consideration of the risk of injury while participating in athletic activities (the “Activity”), and as consideration for the right to participate in the Activity, I hereby, for myself, my heirs, executors, administrators, assigns, or personal representatives, knowingly and voluntarily enter into this waiver and release of liability and hereby waive any and all rights, claims or causes of action of any kind whatsoever arising out of my participation in the Activity, and do hereby release and forever discharge SI Elite Track & Field, Inc., located at PO Box 141049, Staten Island, NY 10314, their affiliates, managers, members, agents, attorneys, staff, volunteers, heirs, representatives, predecessors, successors and assigns, for any physical or psychological injury, including but not limited to illness, paralysis, death, damages, economical or emotional loss, COMMUNICABLE DISEASES INCLUDING COVID-19, that I may suffer as a direct result of my participation in the aforementioned Activity, including traveling to and from an event related to this Activity. I hereby grant permission to SI Elite Track & Field, Inc. to use photographs, name and/or video of me taken on (date) at (location) in publications, news releases, online, and in other communications related to the mission of SI Elite Track & Field, Inc. I, AM VOLUNTARILY PARTICIPATING IN THE AFOREMENTIONED ACTIVITY AND I, AM PARTICIPATING IN THE ACTIVITY ENTIRELY AT MY OWN RISK. I, AM AWARE OF THE RISKS ASSOCIATED WITH TRAVELING TO AND FROM AS WELL AS PARTICIPATING IN THIS ACTIVITY, WHICH MAY INCLUDE, BUT ARE NOT LIMITED TO, PHYSICAL OR PSYCHOLOGICAL INJURY, PAIN, SUFFERING, ILLNESS, DISFIGUREMENT, TEMPORARY OR PERMANENT DISABILITY (INCLUDING PARALYSIS), ECONOMIC OR EMOTIONAL LOSS, AND DEATH. I UNDERSTAND THAT THESE INJURIES OR OUTCOMES MAY ARISE FROM MY OWN OR OTHERS’ NEGLIGENCE, CONDITIONS RELATED TO TRAVEL, OR THE CONDITION OF THE ACTIVITY LOCATION(S). NONETHELESS, I ASSUME ALL RELATED RISKS, BOTH KNOWN OR UNKNOWN TO ME, OF MY PARTICIPATION IN THIS ACTIVITY, INCLUDING TRAVEL TO, FROM AND DURING THIS ACTIVITY. I agree to indemnify and hold harmless SI Elite Track & Field, Inc. against any and all claims, suits or actions of any kind whatsoever for liability, damages, compensation or otherwise brought by me or anyone on my behalf, including attorney’s fees and any related costs, if litigation arises pursuant to any claims made by me or by anyone else acting on my behalf. If SI Elite Track & Field, Inc. incurs any of these types of expenses, I agree to reimburse SI Elite Track & Field, Inc. I acknowledge that SI Elite Track & Field, Inc. and their directors, officers, volunteers, representatives and agents are not responsible for errors, omissions, acts or failures to act of any party or entity conducting a specific event or activity on behalf of SI Elite Track & Field, Inc. I ACKNOWLEDGE THAT THIS ACTIVITY MAY INVOLVE A TEST OF A PERSON’S PHYSICAL AND MENTAL LIMITS AND MAY CARRY WITH IT THE POTENTIAL FOR DEATH, SERIOUS INJURY, AND PROPERTY LOSS. The risks may include, but are not limited to, those caused by terrain, facilities, temperature, weather, lack of hydration, condition of participants, equipment, vehicular traffic and actions of others, including but not limited to, participants, volunteers, spectators, coaches, event officials and event monitors, and/or producers of the event. I ACKNOWLEDGE THAT I HAVE CAREFULLY READ THIS “WAIVER AND RELEASE” AND FULLY UNDERSTAND THAT IT IS A RELEASE OF LIABILITY. I EXPRESSLY AGREE TO RELEASE AND DISCHARGE SI ELITE TRACK & FIELD, INC. AND ALL OF ITS AFFILIATES, MANAGERS, MEMBERS, AGENTS, ATTORNEYS, STAFF, VOLUNTEERS, HEIRS, REPRESENTATIVES, PREDECESSORS, SUCCESSORS AND ASSIGNS, FROM ANY AND ALL CLAIMS OR CAUSES OF ACTION AND I AGREE TO VOLUNTARILY GIVE UP OR WAIVE ANY RIGHT THAT I OTHERWISE HAVE TO BRING A LEGAL ACTION AGAINST SI ELITE TRACK & FIELD, INC. FOR PERSONAL INJURY OR PROPERTY DAMAGE. To the extent that statute or case law does not prohibit releases for negligence, this release is also for negligence on the part of SI Elite Track & Field, Inc., its agents, and employees. In the event that I should require medical care or treatment, I agree to be financially responsible for any costs incurred as a result of such treatment. I am aware and understand that I should carry my own health insurance. In the event that any damage to equipment or facilities occurs as a result of my or my family’s willful actions, neglect or recklessness, I acknowledge and agree to be held liable for any and all costs associated with any actions of neglect or recklessness. This Agreement was entered into at arm’s-length, without duress or coercion, and is to be interpreted as an agreement between two parties of equal bargaining strength. Both the Participant, __as noted on registration form__, and SI Elite Track & Field, Inc. agree that this Agreement is clear and unambiguous as to its terms, and that no other evidence will be used or admitted to alter or explain the terms of this Agreement, but that it will be interpreted based on the language in accordance with the purposes for which it is entered into. In the event that any provision contained within this Release of Liability shall be deemed to be severable or invalid, or if any term, condition, phrase or portion of this agreement shall be determined to be unlawful or otherwise unenforceable, the remainder of this agreement shall remain in full force and effect, so long as the clause severed does not affect the intent of the parties. If a court should find that any provision of this agreement to be invalid or unenforceable, but that by limiting said provision it would become valid and enforceable, then said provision shall be deemed to be written, construed and enforced as so limited. In the event of an emergency, please contact the person(s) noted on the registration form. I, the undersigned participant, affirm that I am of the age of 18 years or older, and that I am freely signing this agreement. I certify that I have read this agreement, that I fully understand its content and that this release cannot be modified orally. I am aware that this is a release of liability and a contract and that I am signing it of my own free will. Accepted by participant noted on registration form.Code Of Conduct* I agree to the Code of Conduct Policy SI Elite Track & Field members shall control their conduct during club workouts, activities, and at races while being respectful to all teammates and opponents and shall conduct themselves in a manner that will ensure the safety of others as to not reflect negatively on the club and its members. SI Elite Track & Field members shall choose their words carefully and shall refrain from talking negatively about others when interacting with teammates, other running clubs and opponents when at club workouts, activities, races, or social media forums. SI Elite Track & Field members shall conduct themselves in a manner that will ensure a comfortable and welcoming club environment. Members are expected to interact with all persons in a manner that avoids behavior that could be construed as discrimination or sexual harassment. Sexual harassment is defined as “Unwanted sexual advances, or visual, verbal or physical conduct of a sexual nature.” SI Elite Track & Field members are expected to respect the age, religion, ethnic background, gender, and sexual orientation of other members. Members are to recognize that the club operates as a sport and social club, however also are to understand that discrimination or unwanted and/or continued advances toward other members will not be accepted and that all members have the right to an environment free from all forms of discrimination, including sexual harassment. SI Elite Track & Field Club members should acknowledge the accomplishments and efforts of others, encouraging all teammates and opponents to excel whilst keeping in mind you represent the club as an ambassador to the community at large. SI Elite Track & Field Club members are responsible to ensure that this Code of Conduct is followed and are expected to report any inappropriate actions or behavior to a club officer. SI Elite Track & Field membership may be terminated by resignation of a member, or by a majority vote of the club officers for violations of this Code of Conduct. SI Elite Track & Field members are expected to adhere to all of the rules of competition in races in which they participate. Members found to be in violation may face reprimand, suspension or other action. SI Elite Track & Field staff takes concerns seriously about code of conduct violations, buying, selling or giving race numbers, or any other violations of the rules of competition. Members who are found to violate the rules of competition will have their membership revoked for the calendar year, after which they can reapply for membership. Please contact SIEliteTF@gmail.com with any questions or concerns regarding the code of conduct or potential infractions. Payment MethodPayPal Checkout MasterCardVisaSupported Credit Cards: MasterCard, Visa Card Number Expiration Date Security Code Cardholder Name CAPTCHA Δ