Firecracker Youth Triathlon July 7, 2002
Entry Form
Print this page, fill in and mail toT
riTucson
PO Box 42947
Tucson, AZ 85733
Last Name________________________ First Name________________________ Phone____________________
Address________________________________________ City______________ State________ Zip_______
Email Address_____________________________________________ (for race confirmation and updates only)
Date of Birth_____/_____/_____ Age on Race Day______ Sex_____
Age groups: 7-8______ 9-10_____ 11-12_____ 13-14______
USATRI member? Yes____ No____ USATRI #__________________
T-Shirt Size: S M L XL (Adult Sizes)
Estimated 200 yard swim time____________ (required for entry acceptance)
Amount enclosed: $____________ (see the
race info sheet for entry fees and deadline dates)
Make check payable to TriTucson
USA Triathlon members must bring membership card to packet pick up- NO EXCEPTIONS
PLEASE READ CAREFULLY BEFORE SIGNING ACKNOWLEDGEMENT, WAIVER AND RELEASE FROM LIABILITY (AWRL)
I acknowledge that a triathlon is an extreme test of a persons physical and mental limits and carries with it the potential for death, serious injury and property loss. I HEREBY ASSUME THE RISKS OF PARTICIPATING IN TRIATHLONS. I certify that I am physically fit, have sufficiently trained for participation in the event and have not been advised against participation by a qualified health professional. I AGREE to a) abide by USA TRIATHLON competitive rules; b) that prior to the race course I will inspect the race course, facilities, equipment and areas to be used; c) WAIVE, RELEASE AND DISCHARGE from any and all claims, losses, or liabilities for death personal injury, partial or permanent disability, property damage,medical or hospital bills , theft, damage of any kind, including economic losses which may in the future arise out of or be related to may participation in a Tucson Racing Inc. event the following persons and/or entities: TUCSON RACING INC., USA TRIATHLON, UNIVERSITY OF ARIZONA, CITY OF TUCSON, AAA LANDSCAPING, PIMA COUNTY, STARLIGHT ,EVENT SPONSORS, RACE DIRECTORS, VOLUNTEERS, ALL STATE, CITY, COUNTY OR LOCALITIES IN WHICH EVENTS OR SEGMENTS OF THE EVENT ARE HELD, THE OFFICERS, AGENTS, DIRECTORS, EMPLOYEES, REPRESENTATIVES OF ANY OF THE ABOVE EVEN IF SUCH CLAIMS AND LOSSES OR LIABILITIES ARE CAUSED BY THE NEGLIGENT ACTS OR OMISSIONS OF THE PERSONS I AM HEREBY RELEASING OR ARE CAUSED BY THE NEGLIGENT ACTS OR OMISSIONS OF ANY OTHER PERSONS OR ENTITY; d) and ACKNOWLEDGE that there may be traffic or persons on the course route (whether associated with the race or not),and I agree that said traffic constitutes a risk for which I am fully aware of and fully assume all risk associated with said traffic and I ASSUME THE RISK OF RUNNING, BIKING OR SWIMMING on the course route. I also ASSUME ANY AND ALL OTHER RISKS ASSOCIATED WITH PARTICIPATING IN THIS EVENT including but not limited to falls, contact with other swimmers or objects in the water, and any hazard that may be posed by weather conditions, defective or poorly maintained equipment, spectators and/or volunteers. All such risks being known, e) I AGREE NOT TO SUE any of the persons or entities mentioned above in paragraph (c) or associated with this event from any claims, losses or liabilities; f) I INDEMNIFY AND HOLD HARMLESS the persons or entities listed above in paragraph (c) from any and all claims made or liabilities assessed against them as a result of (i) my actions or inactions; (ii) the actions or inactions or negligence of others including those as hereby indemnified; (iii) the conditions of the facilities, equipment or areas where the event is being conducted; (iv) the Competitive rules; or (v) any other harm caused by an occurrence related to this event; and (g) grant permission for the use of my name and likeness relating to my participation and waive all rights to compensation as a result of use of my name or likeness. I understand there are no refunds or transfer of entry fees for any reason. I HEREBY CERTIFY THAT I HAVE READ THIS DOCUMENT, UNDERSTAND IT, AND AM OVER EIGHTEEN.
PRINT NAME SIGNATURE DATE
_______________________________________________________________________________________________________For a person under 18 years of age, parent or legal guardian must sign above AWRL and complete below:
The undersigned ____________________________________ , parent and/or legal guardian of ___________________________________ hereby acknowledge that undersigned as executed the foregoing AWRL for and on behalf of the minor named herein. I hereby bind myself, heirs, executors, next of kin, etc., to the foregoing AWRL. I agree agree to hold harmless all persons or entities in the foregoing AWRL for any occurrence or event arising out of the triathlon or the execution of the AWRL or the document.
I authorize a licensed physician or medical person to treat said minor, should I be unavailable for any injuries arising out of this event. I authorize any and all procedures as deemed necessary by medical personal and assume the risk of such procedures for and on behalf of myself and the minor. I acknowledge that no warranty is being made with regard to said medical treatment.
PARENT/GUARDIAN SIGNATURE____________________________________RELATION__________________________DATE________________