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Running Mamas Entry Form July 22nd to September 9th, 2010 8 consecutive Thursdays at 7PM Please complete this entry form and mail your check with the $135 ($125 before July 12th) registration fee to: The Cedars House c/o Ricki Gever Eisenstein 700 Thomas Road Philadelphia, PA 19118 Or stop by The Cedars House Wednesday Through Saturday 7AM-5PM or Sunday 8AM-3PM to pay by Credit Card Last Name: _______________________ First Name: _______________________ Address: __________________________ __________________________ D.O.B.: ________________

Age: ____________

Children’s Name(s) and DOB (or due date): _________________________ ________________________________________________________________ Email address: _____________________ Phone Number: _____________________ T-shirt size: (sizes run small)

S

M

L

XL

Men’s XL

Are you interested in being a Race Captain?

Yes

No

Signature: ____________________________

Date: ________________


Running Mamas guidelines. I will follow all rules made and directions given by Running Mamas and each of its respective agents, representatives, I agree to all conditions stated in the

and employees in connection with the activity. I represent and warrant that I am in good health and that I have no medical, physical, or emotional condition that might interfere with my ability to engage in activity. I am able to run a minimum of 2 miles without stopping or walking. I represent and warrant that I am not under the influence of any medications, drugs, or other substance that might impair my physical or mental ability to engage in this activity or that might impair my judgment while engaging in activity. I understand that I will not be paid any money or given any other consideration for signing this agreement. I understand that I cannot copy, share, give or receive payment by providing this program to those who are not participating. MY PARTICIPATION IN THIS ACTIVITY IS AT MY OWN RISK. I FULLY RELEASE ONE FIT MAMA速, THE CEDARS HOUSE速, AND ALL OTHERS CONNECTED WITH THIS PROGRAM FROM ANY AND ALL LEGAL LIABILITY FOR CONSEQUENCES RELATED TO MY INVOLVEMENT IN

Running Mamas. I will participate in weekly runs and workshops. I am able to (but do not have to) bring a jogging stroller and a child(ren) at any time during the 8 week session. I understand that strenuous exercise and dietary changes may be hazardous for persons who are overweight, have high blood pressure, are over 30, have undiagnosed health problems, or have not participated in a regular exercise program. I further understand that

Mamas

Running

participants are encouraged to consult their physician before taking part in this

program or before making any changes to dietary and exercise routines. I have read the above statements and agree to follow them. Signature: ______________________________ *Waiver for picture taken*: I am willing to have my picture taken and posted on the One Fit Mama速, The Cedars

House and

Running Mamas websites, along with my name. One Fit Mama速 shall have

the right to use my appearance and biographical information in any and all media.

Signature: ______________________________ What race will you be training for? ____________________________________________________________________________________ ____________________________________________________________________________________ What is your biggest obstacle with a running program? ____________________________________________________________________________________ ____________________________________________________________________________________ How often do you run? ____________________________________________________________________________________ ____________________________________________________________________________________ What would you like to gain from participation in the Running Mamas Program? ____________________________________________________________________________________ ____________________________________________________________________________________


Running Mamas Entry Form Entry Form