Cape Coral Triathlon 2015 Entry Form

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Cape Coral Triathlon 2015 Entry Form
Cape Coral Triathlon
2015 Entry Form
First Name: ______________________________
Last Name: ____________________________
Address: ____________________________________________________ Apt #: __________________
City: _______________________________
State: _______________ Zip: ____________________
Phone Number: ______________________ Date of Birth: ____________ Age on 12/31/15: _______
USAT Membership Number*: ___________________________ *REQUIRED FOR REGISTRATION
Adult Shirt Size: S
M
L
Race Division (Please Circle):
XL
Male
Female
Age Group:
9-15
16-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70+
PRE-REGISTRANTS: Will receive a race shirt, race packet, and post-event food and refreshments.
RACE DAY REGISTRATION will be accepted but participants may not receive a t-shirt
EVENT DATE: Saturday May 9, 2015
CHECK IN TIME: 5:30am
START TIME: 7:00am
LOCATION: Cape Coral Yacht Club Community Park, 5819 Driftwood Parkway, Cape Coral, FL 33904
ENTRY FEE: $65 per person (Adult & Youth ages 9 and up)
ONLINE REGISTRATION: Available at http://www.active.com/ until May 1, 2015
PRE-REGISTRATION: Deadline May 1, 2015 (Limit 250 entries)
MAKE CHECK PAYABLE TO: City of Cape Coral **Driver’s License Number & Expiration date is required
on all checks
PAYMENT (Please Circle):
Visa/MasterCard
AMEX
Discover
Name of Card Holder (Please Print): ____________________________________________________
Card Number: ______________________________________________________________________
Expiration Date: _____________
Security Code: ______________
I authorize the City of Cape Coral to charge my purchase to the above credit card for the account listed.
I certify that I am the authorized card holder and that I have full authority to make purchases on the
account listed above. ________________________________________________________________
Card Holder Signature
Date
Cape Coral Yacht Club
5819 Driftwood Parkway
Cape Coral, FL 33904
574-0806 | www.CapeParks.com
Cape Coral Triathlon
2015 Entry Form
City of Cape Coral Parks and Recreation Participant Waiver Form
Incomplete or unsigned entry form cannot be accepted.
In consideration for entry into the Yacht Club Sprint Triathlon, I accept any risk of participation and agree to hold
harmless the City of Cape Coral, Alta Vista Sports, all event sponsors, and all officers, directors, staff and members of said organizations, their respective employees and agents, and any other entities and individuals who are in
any way connected with this event, including volunteers assisting with the event. I understand that this acceptance
of risk and hold harmless agreement is binding on myself and my personal representatives and assigns. I represent
that I have adequately trained to participate in this event and recognize the risks of injury. I acknowledge this release is being relied upon by the above persons in permitting me to participate. Further, I hereby give full permission to any and all of the foregoing to use any photographs, videotapes, motion pictures, recording and any other
record of this event for legitimate purpose.
_____________________________________________________________________________
Participant’s Signature
Date
Print Name of Participant
Date
_____________________________________________________________________________
Minor(s) Name (list each child above)
___________________________________ _______________________________________
Signature of Parent/Guardian
Witness
___________________________________ _______________________________________
Printed Name of Parent/Guardian
Date
RESTRICTIONS and CAUTIONS
For the safety and enjoyment of all, the course is restricted to registered participants and race officials only. Helmets are mandatory during the race, no exceptions. Unregistered participants, unauthorized vehicles, skateboards,
roller-skates, baby/joggers and dogs are strictly prohibited. The following items are prohibited from use or carriage
on the bicycle and run legs (instant disqualification): headphones or headsets, glass containers, IPods or similar.
The risk of running in high temperatures and humidity is inherent to Florida activities. Be sure to drink plenty of
fluids before the start of the event and remember to replace your fluids on the course and after the finish.
Cape Coral Yacht Club
5819 Driftwood Parkway
Cape Coral, FL 33904
574-0806 | www.CapeParks.com