OFFICIAL ENTRY FORM, THE 25th ANNUAL TINMAN TRIATHLON

Send check and signed entry form to:

Tinman Triathlon

c/o Student Activities

600 E. 4th Street

Morris, MN 56267

                                               

LAST NAME

FIRST NAME


                                               

MAILING ADDRESS


                                           

CITY

STATE

ZIP CODE


MALE

FEMALE

     

/

   

/

   

GENDER

AGE

DATE OF BIRTH


DIVISION:

INDIVIDUAL: ________

RELAY: ____ ALL MALE ____ALL FEMALE ____CO-ED ____UMM (current UMM student)

ELITE HEAT:

SWIM HEAT PLACEMENT

If you plan to finish in 2 hours, 5 min.

Check here:

EXACT TIME: ( List Estimated 1100-yard Swim Time )

Under 17 min.

17 — 20 min.

20 — 23 min.

23 — 27 min.

27- 33 min.

  33+ (if over 40 specify)  

IN CASE OF EMERGENCY CONTACT

FULL NAME:

RELATIONSHIP:

FULL DAYTIME PHONE:

T-SHIRT SIZE

M

L

XL

XXL


ADDITIONAL INFORMATION:

DAYTIME PHONE:

EMAIL:


RELAY TEAM NAME:

* EACH TEAM MEMBER MUST SUBMIT THEIR OWN ENTRY FORM

* EACH TEAM MUST SUBMIT A TEAM NAME


RUNNER

BIKER

SWIMMER

______ Please Check here if you are a UMM alumni.

 

 

ACCIDENT WAIVER AND RELEASE OF LIABILITY

I acknowledge that this athletic event is an extreme test of a person s physical and mental limits and carries with it the potential for death, serious injury and property loss. The risks include, but are not limited to, those caused by terrain, facilities, temperature, weather, condition of athletes, equipment, vehicular traffic, actions of other people including, but not limited to, participants, volunteers, spectators, coaches, event officials, and event monitors, and/or producers of the event, and lack of hydration. These risks are not only inherent to athletics, but are also present for volunteers. I hereby assume all the risks of participating &/or volunteering in this event

I certify that I am physically fit, have sufficiently trained for participation in the event, and have not been advised otherwise by a qualified medical person.

I acknowledge that this Accident Waiver and Release of Liability (AWRL) form will be used by the event holders, sponsors and organizers, in which I may participate and that it will govern my actions and the responsibilities at said event

In consideration of my application and permitting me to participate in this event, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows: (A) Waive, Release, and Discharge from any and all liability for my death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter accrue to me or my traveling to and from this event, THE FOLLOWING ENTITIES OR PERSONS: Regional Fitness Center, University of Minnesota Morris, City of Morris, County of Stevens, their directors, officers, employees, volunteers, representatives, and agents, the event holders, event sponsors, event directors, event volunteers; (B) Indemnify and Hold Harmless the entities or persons mentioned in this paragraph from any and all liabilities or claims made by other individuals or entities as a result of my actions during the Tinman Triathlon.

I hereby consent to receive medical treatment which may be deemed advisable in the event of injury, accident and/or illness during the event.

I understand that at this event or related events I may be photographed. I agree to allow my photo, video or film likeness to be used for any legitimate purpose by the event holders, producers, sponsors, organizers, and/or assigns.

This AWRL shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law.

I hereby certify that I have read this document; and, I understand its content.

Name:___________________________ Age:_______ Signature:____________________________ Date:___________

PARENT GUARDIAN WAIVER FOR MINORS (Under 18 years old)

The undersigned parent and natural guardian or legal guardian does hereby represent that he/she is, in fact, acting in such capacity and agrees to save and hold harmless and

indemnify each and all parties referred to above from all liability, loss, cost, claim, or damage whatsoever which may be imposed upon said parties becuase of any defect in or lack of such

capacity to so act and release said parties on behalf of the minor and the parents or legal guardian.

Name:_______________________________ Signature:_________________________________ Date:___________

Make checks payable to: UMM

Memo: Tinman Triathlon

Postmarked on or before April 4th

Through April 17th

Race Day

Individual

$25

$30

$35

Individual — UMM Student

$15

$20

$25

Team

$50

$55

$60

Team — UMM Students

$35

$40

$45

FOR OFFICE USE ONLY

Payment Received Date:

Payment Amount:

Staff Initials: