T-Shirt Size (included with race entry fee)
ChampionChip Number (if applicable
- Example - CE12345)
TRI NorthWest Membership # (if applicable - deduct $10.00 if a member)
Anticipated Finish Time
Check#
Amount Enclosed
WAIVER MUST BE READ, SIGNED AND MAILED WITH ENTRY
OFFICIAL WAIVER: I acknowledge that a Multi-Sport Event is an extreme
test of a person's physical and mental limits and carries with it the
potential for death, series injury, and property loss. I HEREBY ASSUME
THE RISKS OF PARTICIPATING IN THIS EVENT. I certify that I am capable
of completing all disciplines of the event, and that I am physically
fit and that I have sufficiently trained. I agree to abide by the competitive
rules. I hereby take the following action for myself, my executors,
administrators, heirs, next to kin, successors and assigns, or anyone
else who might claim or sue on my behalf, and I hereby 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, or theft which may arise out of or relate to my participation
in this event. I agree not to sue, and to hold harmless any and all
persons, sponsors, volunteers, participants or government agencies for
any and all claims or liabilities that I have waived, released or discharges
herein. I further agree to return the timing Chip that is been issued
to me or to pay a $30 replacement charge. The Entry Fee is Non-Refundable/Non-Transferable.
Type Full Name
Signature X ___________________________________________________________________
(Signature of Parent or Legal Guardian if participant is under the age
of 18)
Date________________________________________