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I acknowledge that a triathlon or multi-sport event is an extreme test of a persons' physical and mental limits and carries with it the potential
for death, serious injury, and property loss. I HEREBY ASSUME THE RISKS OF PARTICIPATING IN ALL TRIATHLON CLUB
FUNCTIONS. I certify that I am physically fit, have sufficiently trained for participation in this event(s), and have not been advised
otherwise by a qualified medical person. I acknowledge that my statements on this AWRL are being accepted by USA Triathlon in
consideration for allowing me to become a club member in a USAT Chartered Club and are being relied upon by USAT and the club
organizers and administrators in permitting me to participate in any organized club function.
In consideration for allowing me to become a club member in a USAT Chartered Club and allowing me to participate in organized club
functions, I hereby take the following action for myself, my executors, administrators, heirs, next of kin, successors, and assigns. A) I
AGREE TO ABIDE BY THE Competitive rules adopted by USA Triathlon, including the Medical Control Rules, as they may be amended
from time to time, and I acknowledge that my club membership may be revoked or suspended for violation of the Competitive Rules; B) I
WAIVE, RELEASE, AND DISCHARGE from any and all claims or liabilities for death, personal injury, property damage, theft or damages
of any kind, which arise out of or relate to my participation in, or my traveling to and from an organized club function, THE FOLLOWING
PERSONS OR ENTITIES; USA TRIATHLON (USAT), USA TRIATHLON chartered clubs, club sponsors, volunteers, all states, cities,
counties or localities in which club functions or segments of club functions are held, and the officers, directors, employees, representatives
and agents of any of the above; C) I AGREE NOT TO SUE any of the persons or entities mentioned above for any of the claims or liabilities
that I have waived, released or discharged herein: and D) I INDEMNIFY AND HOLD HARMLESS the persons or entities mentioned above
from any claims made or liabilities assessed against them as a result of my actions during an organized club function.
I HEREBY AFFIRM THAT I AM EIGHTEEN (18) YEARS OF AGE OR OLDER, I HAVE READ THIS DOCUMENT, AND I
UNDERSTAND ITS CONTENTS.
PRINTED NAME __________________________________________________________ DATE _______________
SIGNATURE __________________________________________________________________________________
****** I am under eighteen (18) years of age. My parent / legal guardian has read and completed the section below.
PARENT OR LEGAL GUARDIAN, PLEASE FILL OUT ADDITIONAL SECTION BELOW.
If the applicant is under 18 years of age, a parent or legal guardian must execute, in addition to the foregoing AWRL, the following for and
on behalf of the minor.
The undersigned____________________________________________ (parent/legal guardian) the parent and
natural guardian or legal guardian of________________________________________________________(Minor's name) hereby executes the foregoing AWRL
for an on behalf of the minor named herein. As the natural or legal guardian of such minor, I hereby bind myself, the minor and our
executors, administrators, heirs, next of kin, successors, and assigns to the terms of the foregoing AWRL. I represent that I have the legal
capacity and authority to act for and on behalf of the minor in the execution of the forgoing AWRL or in the execution of this consent.
I hereby authorize any licensed physician, emergency medical technician, hospital or other medical or health care facility ("Medical Provider") to treat the minor named herein for the purpose of attempting to treat or relieve any injuries received by said minor arising out of or relating to any organized club function. I authorize any such Medical Provider to perform all procedures deemed medically advisable in attempting to treat or relieve any such injuries and any related conditions of said minor that may be encountered during the course of attempting to treat or relieve such injuries. I consent to the administration of anesthesia as deemed advisable during the course of such treatment. I realize and appreciate that there is a possibility of complications and unforeseen consequences in any medical treatment, and I assume any such risk for and on behalf of myself and said minor. I acknowledge that no warranty is being made as to the results of any medical treatment. NOTE: Parent/Legal Guardian must also sign AWRL above. PARENT/LEGAL GUARDIAN SIGNATURE _________________________________________________________ RELATIONSHIP TO MINOR____________________________________________ DATE __________________ |