Blind-Visually Impaired Runners and Sighted Guides: Use this form to sign up for the 2022 season

Question Title

* 1. First Name

Question Title

* 2. First Name

Question Title

* 3. Email Address

Question Title

* 4. Mobile Phone Number

Question Title

* 5. Street Address

Question Title

* 6. Apt, Unit, Suite

Question Title

* 7. City

Question Title

* 8. State

Question Title

* 9. Zip Code

Question Title

* 10. Technical Running Shirt Size

Question Title

* 11. Birthdate

Date

Question Title

* 12. Gender

Question Title

* 13. Any dietary restrictions? 

Question Title

* 14. Employer? (If unemployed, enter none)

Question Title

* 15. Any allergies?

Question Title

* 16. Emergency Contact Name / Relationship

Question Title

* 17. Emergency Contact Phone Number

Question Title

* 18. Fitness Level

Question Title

* 19. How many marathons have you completed?

Question Title

* 20. If running a marathon this year, what is your anticipated finish time? 

Question Title

* 21. How many half marathons have you completed?

Question Title

* 22. If running a half marathon this year, what is your anticipated finish time?

Question Title

* 23. Military Service Participants: Your Branch and Rank

Question Title

* 24. Military Service Participants: Your Military Status

Question Title

* 25. Military Service Participants: Your Service Dates

Question Title

* 26. Military Service Participants: Your Service Dates

USABA Sports Club Event Waiver
UNITED STATES ASSOCIATION OF BLIND ATHLETES
CODE OF CONDUCT, STATEMENT OF ETHICS AND EVENT PARTICIPANT AGREEMENT

The United States Association of Blind Athletes (USABA) Code of Conduct policy and its mandates apply to athletes, staff, governance members, event participants, and volunteers who are members of USABA or participate in USABA events as well as to any contractors whose responsibilities include performing services on behalf of USABA. I understand that agreeing to this form does not provide me with USABA membership or its associated benefits.

I pledge to uphold the spirit of the United States Association of Blind Athletes (USABA) Code of Conduct (the "Code"), which offers a guide to my conduct as a member or participant of the United States Association of Blind Athletes. I acknowledge that I have a right to a hearing if my opportunity to compete is denied or if I am charged with a violation of this Code.

I have familiarized myself with the Code and understand that acceptance of its provisions is a condition of my membership or participation with USABA.

Statement of Ethics:
I acknowledge and agree that USABA affirms and holds as fundamental general ethics principles and organizational values:
Honesty in all dealings;
Respect for others;
Integrity;
Competence in performing tasks within each person’s responsibility;
Accountability for both decisions and the execution of work;
Teamwork;
Diversity;
Equity;
Inclusion; and

Anti-Doping Duties:

It is the duty of individual members and participants of USABA to comply with all anti-doping rules of the World Anti-Doping Agency (WADA), the IBSA, the USOPC including the USOPC National Anti-Doping Policy, and of the U.S. Anti-Doping Agency (USADA), including the USADA Protocol for Olympic and Paralympic Movement Testing (USADA Protocol) and all other policies and rules adopted by WADA, the IBSA, the USOPC and USADA. Athlete members agree to submit to drug testing by the International Association and/or USADA or their designees at any time and understand that the use of methods or substances prohibited by the applicable anti-doping rules make them subject to penalties including, but not limited to, disqualification and suspension. If it is determined that an individual member may have committed a doping violation, the member agrees to submit to the results management authority and processes of USADA, including arbitration under the USADA Protocol, or to the results management authority of the IBSA, if applicable or referred by USADA.”

As a Member or Participant of USABA, I hereby promise and agree that:
I have acted and will act in a sportsmanlike manner consistent with the spirit of fair play and responsible conduct;
I will not commit a doping violation as defined by the Olympic/Paralympic Movement Anti-Doping Code (OMADC), World Anti-Doping Agency (WADA), the United States Anti-Doping Agency (USADA), United States Olympic and Paralympic Committee (USOPC) or the International Blind Sports Federation (IBSA) rules;
I am not currently serving a doping violation and/or do not have a pending or unresolved doping charge;
I will not engage in any conduct that is criminal under any laws applicable to me, including, but not limited to laws governing the possession and use of drugs and alcohol and providing of drugs to any person and of alcohol to minors;
I am eligible to participate under the rules of USABA;
I will respect the property of others whether personal or public;
I will respect members of my team, other teams, volunteers, spectators and officials, and engage in no form of discriminatory behavior or verbal, physical or sexual harassment or abuse;
If I am a coach or staff member, I will complete USOPC SafeSport Program training and will comply with the full spirit and intent of the program;
I will act in a way that will bring respect and honor to myself
I will remember that at all times I am an ambassador for my sport, my country and the Paralympic Movement;
I will respect and comply with all rules, policies, procedures, and regulations of the USOPC as well as USABA;
I will comply with the Olympic Movement Code on the Prevention of Manipulation of Competitions;
I will comply with the laws of the United States of America and each state by whose laws I may be governed;
I will not retaliate in any manner against any person who reports an allegation that I have violated this Code of Conduct; and
I will cooperate in the investigation of any grievance that is filed with USABA, regardless of whether I am the person filing the grievance, the subject of the grievance, or a third person.   
I also acknowledge and agree to the following:

I risk bodily injury, including paralysis, dismemberment and death as well as loss or damage to property;
I knowingly and freely assume all such risk;
I hereby authorize and give my full consent to USABA to copyright and/or publish any and all photographs, videotapes and/or film in which I appear while attending any USABA event. I further agree that USABA may transfer, use or cause to be used these photographs, videotapes or films for any exhibitions, public displays, publications, commercials, art and advertising purposes and television programs without limitations or reservations; and
 
I, for myself and on behalf of my heirs, assigns and next of kin, hereby release, hold harmless and promise not to sue the United States Association of Blind Athletes, their officers, officials, agents and/or employees, with respect to any such injury, paralysis, dismemberment, death and/or loss or damage to property except that which is the result of gross negligence and/or wanton misconduct.
Code of Conduct Enforcement Information

The person responsible for administration of this Code of Conduct generally is Kevin Brousard at USABA, kbrousard@usaba.org, 719.866.3019. 

Additional information concerning member rights can be obtained from the Office of the USOPC Athlete Ombuds (https://www.teamusa.org/Athlete-Ombuds). 

The Code of Conduct is administered in accordance with the USABA Grievance, Complaint and Appeal Procedures (“Grievance Procedures”).  For complete information concerning the Grievance Procedures, members can access the Grievance Procedures online at USABA’s website.  By way of summary, any reports concerning violation of the Code of Conduct are received by the USABA Judicial Committee, which is responsible for investigation of any grievance.  If a grievance is determined to be viable upon initial review, the Judicial Committee appoints a hearing panel (which will include at least one-third of its members as qualified athletes) to hear the grievance after providing the member with notice and an opportunity to be heard by disinterested hearing panel members.

PARTICIPANTS' AFFIRMATION

I have read and accept this Code of Conduct and Program Participant Agreement. I agree to the rules, guidelines, jurisdiction and procedures stated in these documents as a condition of maintaining my USABA membership. For athletes of minority age – (under 18 at time of registration), this is to certify that I, as a parent/guardian of this participant, consent to his/her release of the United States Olympic and Paralympic Committee and the United States Association of Blind Athletes from any and all liabilities incident to his/her involvement in the programs conducted at authorized training and competition sites.

Question Title

* 27. By checking here, this is to certify that I, or as a parent/guardian of this participant, have read and accept the Code of Conduct and Program Participant Agreement above. I agree to the rules, guidelines, jurisdiction and procedures stated in these documents as a condition of eligibility for participation.

Question Title

* 28. Are you registering to be a blind/visually impaired runner or sighted guide? 

T