Bay State Triathlon Team 2014 Season
Online Application and Waiver
Date: ____________________
Last
Name__________________________ First Name_______________________ MI_____
Street
Address_______________________________________________________
City_____________________________
State_____ Zip________
Birth Date_____________
Home Phone (___) __________
Work Phone (____)
______________
E-mail Address
_______________________ Experience Level: ____________________
USAT Member #
_____________________ Expires: ______________
Check here if you would like to have a mentor from the Club ____
EMERGENCY INFORMATION:
In case of emergency,
please notify:
Name
___________________________________
Address______________________________________________________________
Telephone
__________________________
Privacy Notice
BSTT provides a list
of club members’ names addresses and email to USA Triathlon so that members
will be eligible for the annual membership discount.
___ I do not want my
information released to USAT
___ I do not want my name,
town and email listed on the team website
___ I do not want my
information released to official team sponsors
Annual Dues: $100.00
Paid ( ) Date:
_________________
Make checks payable to: Bay State Triathlon Team
Mail
to: Steve O'Callaghan
85 Pilgrim Trail
Marshfield,MA
02050
Waiver
(Signature and date
required)
Please read carefully
before signing acknowledgment, waiver and release from liability (AWRL).
I acknowledge that a
triathlon/multi-sport event is an extreme test of a person’s physical and
mental limits and carries with it potential for death, serious injury and
property loss. I HEREBY ASSUME THE RISKS OF PARTICIPATING IN
TRIATHLON/MULTI-SPORT TRAINING AND COMPETITION. I certify that I am physically
fit and have sufficiently trained for participation in triathlon/multi-sport
events, and have not been advised against participation by a qualified health
professional. I acknowledge that my statements on this AWRL are being accepted
by Bay State Triathlon Team in consideration for allowing me to become a member
of BSTT and are being relied upon by BSTT and its SPONSORS in permitting me to
participate in any BSTT event.
In consideration for
allowing me to become a member of BSTT and allowing me to participate in BSTT
events, I hereby take the following action for myself, my executors,
administrators, heirs, next of kin, successors and assigns, or anyone else who
might claim or sue on my behalf, and I expressly acknowledge that it is my
intent to take these actions: (a) I AGREE that prior to participating in an
event I will inspect the course, facilities, equipment, and areas to be used
and if I believe any are unsafe I will immediately advise the person
supervising the event activity facilities or area; (b) I 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, theft or damage of any kind, including economic losses, which may in the
future arise out of or be related to my participation in or my traveling to and
from an BSTT event, THE FOLLOWING PERSONS OR ENTITIES: BSTT, BSTT BOARD OF
DIRECTORS, SPONSORS, RACE DIRECTORS, EVENT PRODUCERS AND VOLUNTEERS EVEN IF
SUCH CLAIMS, LOSSES, OR LIABILITIES ARE CAUSED BY THE NEGLIGENT ACTS OR
OMISSIONS OF THE PERSONS I AM HEREBY RELEASING OR ARE CAUSED BY THE NEGLIGENT
ACTS OR OMISSIONS OF ANY OTHER PERSON OR ENTITY; (c) I ACKNOWLEDGE, that there
may be traffic or persons ON THE course, route and I ASSUME THE RISK OF
RUNNING, BIKING, SWIMMING OR PARTICIPATING IN ANY OTHER BSTT EVENT. I also
ASSUME ANY AND ALL OTHER RISKS associated with participating in BSTT sanctioned
events including, but not limited to, falls, contact and/or effects with other
participants, effects of weather including heat and/or humidity, defective
equipment, the condition of the roads, water hazards, contact with other
swimmers or boats and any hazard that may be posed by spectators or volunteers.
All such risks being known and appreciated by me, I further acknowledge that
these risks include risks that may be the result of the negligence of the
persons or entities mentioned above in paragraph (b) or of other persons or
entities; (d) I AGREE NOT TO SUE any of the persons or entities mentioned above
in paragraph (b) for any of the claims, losses, or liabilities that I have
waived, released, or discharged herein; (e) I IDENTIFY AND HOLD HARMLESS the
persons or entities mentioned above in paragraph (b) from any and all claims
made or liabilities assessed against them as a result of: (i) my actions or
inaction’s; (ii) the action’s, inaction’s or negligence of others including
those parties hereby indemnified; (iii) the conditions of the facilities,
equipment or areas where the event or activity is being conducted; or (iv) any
other harm caused by occurrence related to an BSTT event.
I HEREBY AFFIRM THAT I AM
EIGHTEEN (18) YEARS OLD OR OLDER, I HAVE READ THIS DOCUMENT, AND I UNDERSTAND
ITS CONTENTS.
_______________________________
PRINT NAME
_______________________________
SIGNATURE
_______________________________
DATE