Mail to:
Kirkland Tri
c/o
AA Sports, Ltd.
4836 SW Western Ave
Beaverton, OR 97005
Event (Choose One - FOR AGES 12 & UNDER)
Individual
INDIVIDUAL (entry includes T-shirt & medal)
CATEGORY - Choose One Depending on ability or age
First Name / MI
/ Last Name
Street Address
City
State/Province
Zip/Postal Code
Birthdate - mm/dd/yy
Age
Gender
Phone
Email
T-Shirt
Size (included with race entry fee)
Check#
Amount Enclosed
WAIVER MUST BE READ, SIGNED AND MAILED WITH ENTRY
OFFICIAL WAIVER: I certify that my child is capable of completing all
disciplines of the event. As Parent/Guardian 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 child's 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.
Type Full Name
Signature X ___________________________________________________________________
(Signature of Parent or Legal Guardian if participant is under the age
of 18)
Date________________________________________