Indian Lake Elementary Running Club Pick-Up and Information Form

Fields marked with a * are required.


Persons responsible for pickup: (Must list all persons with whom the student may be released.) **Please place additional information here if necessary**

(Name / Relationship / Phone)

It is hereby acknowledged that running can be potentially dangerous and I assume all risks on behalf of my child. By consenting for my child to participate in the Indian Lake Elementary After School Running Club, I hereby release for myself and on behalf of my child, Indian Lake Elementary, the Sumner County Board of Education and Sumner County, Tennessee and anyone or other organization involved in the Indian Lake Elementary After School Running Club or the event, their employees, agents or representatives, from any and all claims of liabilities of any kind whatsoever arising out of my child’s voluntary participation in the Indian Lake Elementary After School Running Club.

By checking the box below, I/we hereby consent for my child/children to participate in the After School Running Program at Indian Lake Elementary as they practice and/or prepare for the upcoming Music City Marathon for Kids.
This acknowledgement of risk and consent to allow participation shall remain in effect until revoked in writing.

My child is adequately and currently covered by accident insurance that will cover injuries sustained while participating in the Indian Lake Elementary Running Program.

Insurance Information
Please complete the information below to verify insurance coverage for your child for the 2016 – 2017 school year.