NORTH CENTRAL COLLEGE TRACK CLUB

 2007 APPLICATION

Name:_______________________________________________________________________________________

Address:_____________________________________________________________________________________

City:____________________________State:___________Zip Code:___________Date of Birth:______________

Telephone Number:_______________________________E-Mail Address:________________________________

Do you want to be included in the NCCTC name and address roster?                       YES ________         NO ________

Do you want to be listed on the Website (ncctrackclub.com)?                                   YES ________         NO ________

MEMBERSHIP DUES

Members who use the track for Wednesday night workouts are:  $50.00.

Please make check payable to the:   North Central College Track Club.

Mail checks to:   Kevin M. Gensler, 968 Collingwood Drive, Naperville, Illinois 60540 (Phone: 630/420-2849)

WAIVER: I know that training for, or participating in, an athletic event is potentially a hazardous activity.  I should not train and/or participate unless I am medically able and properly conditioned.  I agree to abide by any decisions of training officials and/or event officials relative to my ability to safely train or complete an event. I assume all risks associated with training for, or participating in, such events including, but not limited to, falls, contact with other participants, spectators, the effects of the weather, including heat and/or humidity, traffic and the conditions of the road or track.  All such things being known and appreciated by me, having read this waiver and knowing these facts and in consideration of your accepting my application for membership, I, for myself, my family members, and anyone acting on my behalf, waive and release North Central College, its officers, directors and athletic department; Naperville Central High School, its offices, directors and athletic department; Naperville Unit School District 203, its offices, directors and athletic department, and North Central College Track Club, its officers and directors from all claims or liabilities of any kind arising out of my participation in such events, even though that liability may arise out of negligence or carelessness on the part of the persons or entities named in this waiver.

Signature_________________________________________________