Kiwanis Kids Triathlon Race Day Registration

Race # assigned: _________________ (To be filled in by Race Director)

Age as of Dec 31:________ 

Gender: _________  

Last Name _______________________________________ 

First Name _______________________________________

USA Triathlon member #: _____________________

Address___________________________________________________

City ________________ State ______   Zip ________ 

Phone ______________________________ 

Email___________________________________________

DOB ________________ 

Cost: $30 on race day. 

All participants must be members of USA Triathlon. You may purchase an annual USA Triathlon youth membership for just $5 at www.usatriathlon.org.  The participant will be asked to provide a membership number at the time of race check-in.

Waiver

I acknowledge that triathlon is an extreme test of a person's physical and mental limits and carries a potential for death, injury, and property loss. I HEREBY ASSUME THE RISKS ON BEHALF OF MY CHILD OF PARTICIPATION IN THE KIWANIS KIDS TRIATHLON SERIES. I hereby certify that he/she is capable of completing all three segments, that he/she is physically fit and that he/she has sufficiently trained for this event. I agree not to sue and will hold harmless any persons, sponsors, volunteers, participants, or USA Triathlon for any and all claims or liabilities that I've waived, released or discharged herein. I hereby authorize medical treatment for any and all injuries sustained by my child during this event. I understand and take full risk on behalf of myself and said minor.

____________________________________   _________________

Participant's Signature                                              Date

____________________________________   _________________

Parent/Guardian's Signature                                  Date

Entry is incomplete without both signatures.