CP Classic Running Club
P.O. Box 1085
Cedar Park, Texas  78630

Web: www.cpclassic.com

E-Mail: cpclassic@io.com

Telephone: 512-401-9440

ATHLETE INFORMATION

Last Name:

First Name:

M.I.

New Member - $210: ________          Returning Member - $180: ________

Male: _______     Female: _______

New Members get competition singlet and dry-fit t-shirt with membership.

Returning Members get a dry-fit t-shirt and can buy a singlet, if needed:

Singlet size:  Youth S   /   M   /   L   -  Adult  S   /   M   /   L   /   XL   /   XXL

T-Shirt size:  Youth S   /   M   /   L   -  Adult  S   /   M   /   L   /   XL   /   XXL

Birth Date:          /          /

Medical Conditions:

PARENT / EMERGENCY INFORMATION

Mother's Last Name:

Mother's First Name:

Father's Last Name:

Father's First Name:

Address:

City:

State:

Zip:

Telephone #s (home, cell., work, etc.):

Email Address(es):

Emergency Contact:

Telephone: (            )

MEDICAL CONSENT AND RELEASE OF LIABILITY

I, the undersigned parent/guardian listed above, do hereby authorize the CP Classic Running Club, Inc. (CP Classic), its coaches and authorized officers as Agents for the athlete listed above and consent to treatments and examinations deemed medically necessary.  I hereby release and discharge the CP Classic, its coaches and authorized officers from any and all claims for personal injuries.  I agree that any pictures and/or performances resulting from program activities is public information and may be used for promotional purposes and media releases.  Participation in the program shall constitute acceptance of the conditions set forth in this release even in lieu of signatures or payment.  As the undersigned parent/guardian, I understand that no refunds can be given.  Paid members of the CP Classic will be provided with accidental insurance for sanctioned competitions and practices by the Amateur Athletic Union (AAU) and/or the Texas Amateur Athletic Federation (TAAF).

Parent's/Guardian's Signature:

Date: