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EZ8 Running4Women
SECURE ONLINE REGISTRATION FORM

Use this online form if you are paying by credit card only.
If you want to mail in/fax in your form, click on the appropriate form to download:
NOTE: We cannot guarantee your space will be reserved if you do not supply us with payment information on this form.

Email Address:
Full Name:
Street Address:
City:
State:
Zip:
Date of Birth, Please include year:
Best Contact Phone Number w/area code (i.e. cell phone):
I rate my current fitness level as: (Ten being high):
Please tell us how you heard about us:
Running group registering for:
This is my first time with EZ8 Running4Women:	Yes No
Emergency Contact Name and Phone #:
I will be paying by:	Mastercard Visa American Express Discover
Credit Card Number:
Exp Date:
CVC code (on front or back of credit card):*
Name as it appears on card:
Billing address of Credit Card if different than above address:
Note: If paying by check, do not use this online form. *Please download the mail-in form above.* For security reasons, your credit card information is not stored or saved within our system. Your credit card information is required at this time to process your registration.
1. Are you allergic to any medication, food or bug bites? Please list:
2. Do you take any prescribed medication (permanent/semi-permanent)? Please list:
3. Do you have a seizure disorder (epilepsy)?	Yes No
4. Do you have diabetes?	Yes No
If yes to above, please list medications:
5. Do you have asthma?	Yes No
6. Do you have High Blood Pressure (hypertension)?	Yes No
If yes to above, please list medications:
7. Do you have or have you ever had the following diseases? (check all that apply)	Heart Disease Lung Disease Kidney Disease Liver Disease
8. Have you ever been found to be anemic (low blood count)?	Yes No
9. Have you ever had a sever neck injury? If Yes, please describe:
10. Have you ever been knocked out? Please describe:
11. Do you wear glasses or contact lenses?	Yes No
12. Have you had a broken bone or fracture in the past 2 years? Please describe:
13. Have you ever injured your back?
14. Do you have back pain?	Never Seldom Occasionally Frequently Only with vigorous exercise
15. Have you had knee pain in the past 2 years that has disabled you for longer than a week? Please describe:
16. Do you have other physical conditions which cause you pain? Please describe:
17. Please detail any surgical procedures:
18. Please describe your GOALS for the next 3-months and WHY?
19. Have you had your body fat tested? If yes, what percent is it?
20. Are you training for a specific event? If yes, explain:
21. What do you think your timed mile will be?
22. How much have you been running lately?
*NOTICE: It is wise to seek your doctor’s advice before beginning any health/fitness/nutrition program!* RELEASE This release is entered into between the undersigned and EZ8 Running, its officers, affiliates, and executors. The City of Snoqualmie, Washington. The purpose of EZ8 Running is to provide fitness instruction and coaching for various levels of athletes/individuals.The undersigned hereby acknowledge that the following was explained to me and/or agree to the following : 1. Acknowledges that Kimbrough Kendall is not a physician and is not trained in any way to provide medical diagnosis, medical treatment, or any other type of medical advice. 2. Acknowledges that Kimbrough Kendall will provide fitness instruction and coaching to the undersigned, but that Kimbrough Kendall does not guarantee neither good nor bad results. 3. Acknowledges that the undersigned has been told if they feel tired, feel pain or feel out of the ordinary in any way either related to your training, or otherwise, that the undersigned should contact a physician at once. 4. Acknowledge that the undersigned will not hold Adventure Boot Camp, EZ8 Runners4Women, or any of its affiliates liable for injury, loss or work, or death. 5. Acknowledges that the undersigned assumes the risks of participating in fitness training, that they are fit, and they have a regular medical physician they can contact regarding any medical problems that they might develop. The undersigned expressly waive, release, discharge and agree not to sue from any liability of death, disability, personal injury, or action of any kind Kimbrough Kendall for the undersigned participating in said sporting events and/or training for said sporting events. The Undersigned agrees that this is the full agreement between the parties, that Kimbrough Kendall, nor anyone else has not verbally contradicted any of the terms of this release and that the undersigned has entered into this agreement free and voluntarily without force or coercion. I understand there is no refund policy. I will remember to set my alarm and be at set location at designated time. I will be dedicated to this program and give my very best. I will have FUN!
Yes, I have read and agree to all terms and conditions.