GenSan Run Club

About GRC

The GenSan Run Club is a non profit, all volunteer organization that unites runners and walkers in General Santos City. In addition to competing in numerous races, we offer year round training runs, an interval training track night, recreational and travel activities, and social gathering, we are dedicated to promoting healthy and enduring friendship.

Ten Reasons to Join

1. Regular schedule interval, tempo, long slow distance, recovery and hill group runs at various distance for all abilities; 2. Group participation in various fun runs, marathons and relays; 3. Fun social activities; 4. Discounts for select local races; 5. Specially negotiated hotel rates for select out or town marathons; 6. Pre marathon pasta load dinners; 7. Inexpensive membership dues; 8. Training schedules available exclusively to member; 9. Philanthropic activities; 10. Friendly, warm and welcoming members.

Official Website: www.gensanrunclub.com

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MEMBERSHIP APPLICATION
NAME: ___________________________________________________________ GENSAN ADDRESS: ___________________________________________________________
PERMANENT ADDRESS:

___________________________________________________________ GENDER: MOBILE PHONE: ___________________________________________________________ ___________________________________________________________

EMAIL ADDRESS: ___________________________________________________________ OCCUPATION: ___________________________________________________________ ___________________________________________________________ POSITION: ___________________________________________________________

EMPLOYER/COMPANY:

EMERGENCY CONTACT: NAME: RELATIONSHIP:

ADDRESS:

___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________

CONTACT NUMBER: ___________________________________________________________

Waiver of Consent
I acknowledge, agree, and represent that I understand the nature of running and that I am qualified, in good health, and in proper physical condition to participate in such activity.

I further agree and warrant, that if, at any time, I believe the conditions to be unsafe, I will immediately discontinue further participation in running activities.

__________________________ Signature over printed name

Official Website: www.gensanrunclub.com

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Beginners and applications age 40 years old and above must present a medical clearance upon application.

MEDICAL HISTORY QUESTIONNAIRE

PLEASE PRINT IN CAPITAL LETTERS
NAME: _______________________________________________ NO.: __________________________ EMERGENCY CONTACT: _________________________________ PHONE NO.:_____________________

Please encircle the correct answer. All Information herein shall be considered confidential.
YES NO 1. Are you allergic to any general medication (aspirin, penicillin, etc.)? if so please indicate what medicine/s._________________________. YES NO 2. Are you now on any prescribed medication on a permanent or semi permanent basis? If so, please indicate the name of the medication and why it was prescribed. YES NO 3. Have you ever had an epileptic seizure or have been informed that you might have epilepsy? YES NO 4. Have you ever been treated for diabetes? If so, please indicate the type(s) of insulin or pills you use. _______________________ YES YES NO 5. Has a medical doctor ever told you that you were anemic?

NO 6. Do you have or have ever had high blood pressure? If so, list any medication for it that you take regularly. _________________________.

YES

NO 7. Do you have or have you ever had any of the following diseases? If so, please encircle the appropriate ones. Heart disease (rheumatic fever) Kidney disease(infections) Liver disease(hepatitis) Lung disease(pneumonia)

YES

NO 8.Have you ever been informed by a medical doctor that you have asthma? If so, what

Official Website: www.gensanrunclub.com

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medication, if any, that you take regularly._________________________ YES YES NO 9.Do you wear contact lenses?

NO 10.Have you had a fracture during the past 2 year? If yes, indicate which bone was broken and the date that it happened. _______________________

YES YES

NO NO

11. Have you ever had an injury to your back? 12. Do you experience pain in your back? If yes, indicate frequency: Seldom with vigorous exercise occasionally with heavy lifting frequently

YES YES

NO 13. Have you injured your knee during the past 2 years with severe swelling as a result? NO 14. Have you ever been told that you injured the ligaments and / or cartilage of either knee?

YES YES YES YES

NO 15. Have you ever been advised to have surgery to correct a knee problem? NO 16. If the answer to No. 15 is yes, has the surgery been completed? Date ___________ NO 17. Have you experienced a severe sprain of either ankle during the past 2 years? NO 18. Have you had any injury to your foot or toes in the past 2 years? If yes, please Explain. _______________________________________________________.

YES

NO 19. Do you have any chronic conditions that have not been mentioned above? If so, Explain. _______________________________________________________________

The questions of these forms have been answered completely and truthfully to the best of my knowledge.

Signature: ___________________________________________ _______________ Parent/Guardians Signature __________________ ___________ _______________

Date: Date:

Official Website: www.gensanrunclub.com

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You can submit this filled form to any of the GRC officers on General Assemblies or at any designated GRC Headquarters. Posted: February 2012

Official Website: www.gensanrunclub.com