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Applicant Information
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Name: |
Age: |
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Email: |
Phone: |
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Current address: |
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City: |
State: |
ZIP Code: |
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Gender:c
Male c Female |
Meal choice: c Vegetarian c Omnivore |
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TRAINING Information
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Distance you are training for: c Sprint c Olympic
c Half Iron
c Ironman |
How many years have you done tris? |
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Distance of longest tri? |
Length of Long Run Preference:_____ |
Length of Ride Preference: c 30 miles c 50 miles
c 80 miles c other:____ |
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Emergency Contact
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Name of contact: |
Relationship: |
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Address: |
Phone: |
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City: |
State: |
ZIP Code: |
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Relationship: |
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WAIVER of LIABILITY/ASSUMPTION OF RISK
PLEASE
READ CAREFULLY
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I hereby acknowledge for myself, executors,
heirs and administrators, and for anyone else who might sue on my behalf that
it is my intent to take these actions. I acknowledge that a triathlon or
biathlon/duathlon event as an extreme test of a person’s 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 or
biathlon/duathlon events. I certify that I am physically fit and have sufficiently
trained for participation in this event(s), and have not been advised against
participation by a qualified health professional. I acknowledge that my
statements on this AWRL are being accepted by Brooklyn Tri Club (BTC) in
consideration for allowing me to become a participant in the Training Camp
and are being relied upon by BTC and the various coaches, organizers, and
administrators in permitting me to participate in any BTC events and
workouts. In consideration for allowing me to participate in BTC and USA
Triathlon events, I hereby take the following actions: (a) I AGREE to abide
by the Competitive Rules adopted by USA Triathlon, including the Medical
Control Rules as they may be amended from time to time, and I acknowledge
that my membership may be revoked or suspended for violation of the
Competitive Rules; (b) I AGREE that prior to participating in an event I will
inspect the race course, facilities, equipment and areas to be used and if I
believe they are unsafe I will immediately advise the person supervising the
event activity, facility, or area; (c) I 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, or
damage of any kind, including economic losses, which may in the future arise
out of or relate to my participating in or my traveling to and from a BTC
event, THE FOLLOWING PERSONS OR ENTITIES: BTC, USA Triathlon, event sponsors,
race directors, event producers, volunteers, all states, cities, counties, or
localities in which events or segments of events are held, and the officers,
directors, employees, representatives, and agents of any of the above, even
if such claims, omissions or liabilities are caused by the negligent acts or
omissions of the persons I am hereby releasing or are caused by the negligent
acts of omissions of any other person or entity; (d) I ACKNOWLEDGE that there
may be traffic or persons ON THE course route, and I ASSUME THE RISK OF
RUNNING, BIKING, SWIMMING OR PARTICIPATING IN ANY OTHER BTC EVENT. I also
ASSUME ANY AND ALL OTHER RISKS associated with participating in BTC
events including but not limited to falls, contact and/or effects with other
participants, effects of weather including heat and/or humidity, defective
equipment, the condition of the roads, water hazards, contact with other
swimmers or boats, and any hazard that may be posed by spectators or
volunteers. All such risks being known and appreciated by me, I further acknowledge
that these risks include risks that may be the result of the negligence of
the persons or entities mentioned above in paragraph (c) or of other persons
entities. (e) I AGREE NOT TO SUE any of the persons or entities mentioned
above in paragraph (c) for any of the claims, losses or liabilities that I
have waived, released or discharged herein. (f) I INDEMNIFY AND HOLD HARMLESS
the persons or entities mentioned 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, inactions, or negligence of others
including those parties hereby indemnified (iii) the conditions of the
facilities, equipment or areas where the event or activity is being conducted
(iv) the Competitive Rules or (v) any other harm caused by an occurrence
related to a BTC event. |
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Signature
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I HEREBY AFFIRM THAT I AM EIGHTEEN (18) YEARS OF AGE OR
OLDER, I HAVE READ THE DOCUMENT AND I UNDERSTAND ITS CONTENTS |
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Signature of applicant: |
Date: |
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*Mail application
plus $250 check made out to “Brooklyn Tri Club” to E. Johnson,