ChampionChip
Number (if applicable - Example - CE12345)
TRI NorthWest Membership # (if applicable) - members
deduct $5.00:
USAT Membership Number (If applicable)
ONE-DAY USAT FEE (You must purchase a one-day USAT membership for $10 if
you are not currently a USAT member)
Purchase Massage ($15)
Check#
Amount Enclosed
WAIVER MUST BE READ, SIGNED AND MAILED WITH ENTRY
OFFICIAL WAIVER: IN CONSIDERATION of USA Triathlon ("USAT") allowing
me to participate in any USAT sanctioned event (the "Event" or
"Events") as either a member of USAT or through the issuance of
a single event license or permit; I, for myself, and on behalf of my spouse,
children, parents, guardians, heirs and next of kin, and any legal and personal
representatives, executors, administrators, successors and assigns, hereby
agree to and make the following contractual representations pursuant to
this Waiver and Release of Liability, Assumption of Risk and Indemnity Agreement
(the "Agreement");
1. I hereby represent
that (i) I am in good health and in proper physical condition to participate
in the Event; and (ii) I am not under the influence of alcohol or any
illicit or prescription drugs which would in any way impair my ability
to safely participate in the Event. I agree that it is my sole responsibility
to determine whether I am sufficiently fit and healthy enough to participate
in the Event.
2. I understand and
acknowledge the physical and mental rigors associated with triathlon,
duathlon, or other multi-sport events, and realize that running, bicycling,
swimming and other portions of such Events are inherently dangerous and
represent an extreme test of a person's physical and mental limits. I
understand that participation involves risks and dangers which include,
without limitation, the potential for serious bodily injury, permanent
disability, paralysis and death; loss or damage to property; exposure
to extreme conditions and circumstances; accidents, illness, contact or
collision with other participants, spectators, vehicles or other natural
or manmade objects; dangers arising from adverse weather conditions; imperfect
course conditions; water, road and surface hazards; equipment failure;
inadequate safety measures; participants of varying skill levels; situations
beyond the immediate control of the Event Organizers; and other undefined
harm or damage which may not be readily foreseeable, and other presently
unknown risks and dangers ("Risks"). I understand that these
Risks may be caused in whole or in part by my own actions or inactions,
the actions or inactions of others participating in the Event, or the
acts, inaction or negligence of the Released Parties defined below, and
I hereby expressly assume all such Risks and responsibility for any damages,
liabilities, losses or expenses which I incur as a result of my participation
in the Event.
3. I agree to be familiar
with and abide by the Rules and Regulations established for the Event,
including but not limited to the Competitive Rules adopted by USAT and
the Guide to Prohibited Substances and Prohibited Methods of Doping adopted
by the United States Anti-Doping Agency. I also accept sole responsibility
for my own conduct and actions while participating in the Event, and the
condition and adequacy of my equipment.
4. I hereby Release,
Waive and Covenant Not to Sue, and further agree to Indemnify, Defend
and Hold Harmless the following parties: USAT, the Event Organizers and
Promoters, Race Directors, Sponsors, Advertisers, Host Cities, Local Organizing
Committees, Venues and Property Owners upon which the Event takes place,
Law Enforcement Agencies and other Public Entities providing support for
the Event, and each of their respective parent, subsidiary and affiliated
companies, officers, directors, partners, shareholders, members, agents,
employees and volunteers (Individually and Collectively, the "Released
Parties" or "Event Organizers"), with respect to any liability,
claim(s), demand(s), cause(s) of action, damage(s), loss or expense (including
court costs and reasonable attorneys fees) of any kind or nature ("Liability")
which may arise out of, result from, or relate to my participation in
the Event, including claims for Liability caused in whole or in part by
the negligence of the Released Parties. I further agree that if, despite
this Agreement, I, or anyone on my behalf, makes a claim for Liability
against any of the Released Parties, I will indemnify, defend and hold
harmless each of the Released Parties from any such Liability which any
may be incurred as the result of such claim.
I hereby warrant that
I have read this Agreement carefully, understand its terms and conditions,
acknowledge that I will be giving up substantial legal rights by signing
it (including the rights of the minor, my spouse, children, parents, guardians,
heirs and next of kin, and any legal and personal representatives, executors,
administrators, successors and assigns), acknowledge that I have signed
this Agreement freely and voluntarily, without any inducement, assurance
or guarantee, and intend for my signature to serve as confirmation of
my complete and unconditional acceptance of the terms, conditions and
provisions of this Agreement. This Agreement represents the complete understanding
between the parties regarding these issues and no oral representations,
statements or inducements have been made apart from this Agreement. If
any provision of this Agreement is held to be unlawful, void, or for any
reason unenforceable, then that provision shall be deemed severable from
this Agreement and shall not affect the validity and enforceability of
any remaining provisions.
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________________________________________