Printable Registration Form: Please Fill-out the form completely
Event Name: ____________________________________________ Event Date: _____________
Participant Name: _______________________________________ Age as of Race Day _______ Birth date _____/______/________
________ Check here for Male 200+ Category
For XTERRA ONE ONLY: Age as of 12.31.08 __________ Would you like to compete in the Challenged Athlete Division? ______ (check)
XTERRA I.D.# __________________________________ USAT # (for XTERRA ONE) ____________________________
For SummiTriathlon ONLY: Check Here for OPEN/ELITEDivision ________
Address: _______________________________________________________________
City: ______________________________________ State: _______ Zip: ________________________
E-mail: ____________________________________ Male / Female (circle)
Phone: ( ________ ) ____________ - _________________________
T-shirt: (CIRCLE) Small Medium Large XL XXL
Be sure to mail-in entry form to the correct registration address.
FEE TABLE:
READ CAREFULLY BEFORE SIGNING THE RACE DISCLAIMER:
I understand that the sport of RUNNING, DUATHLON, and/or TRIATHLON, which
involves the sports of swimming, biking, and running are an extreme test of my, or my child's, physical and mental limits
and carries the potential for serious risks. I agree,attest and certify that by signing this registration
form, I WAIVE, RELEASE, AND FOREVER DISCHARGE FROM ANY AND ALL RISKS, CLAIMS,
LOSSES, OR LIABILITIES, WHICH OCCUR TO ME, OR MY CHILD, AS A RESULT OF MY/CHILD'S
PARTICIPATION IN THIS EVENT. SUCH RISKS, CLAIMS, LOSSES, OR LIABILITIES INCLUDE,
BUT ARE NOT LIMITED TO:death, injury, partial or permenant disability ordismemberment,
property loss and/or damage, medical and hospital bills, attorney fees and court/litigation expenses, theft of any items,
or any aforementioned claim, loss, or liability as a result of traveling to and from any and all CHAMP Racing, LLC directed
events. I assume, acknowledge, and are aware of additional dangers and risks associated with this event.
Such additional risks include but are not limited to falls, contact with other participants/volunteers,
effects of weather including heat, cold, and/or humidity, road/pavement conditions including
but not limited to potholes, curbs, gravel, dirt, tree/environmental debris, independent
construction equipment, surrounding natural environmental hazards, any hazard associated
or posed by other participants, spectators, non-participating pedestrians/joggers, or volunteers,
any hazards associated with equipment for event maintenance, control, organization, and safety
including, but are not limited to directions signs, post, cones, banners/flags, and bike racks.
I FURTHER UNDERSTAND AND ACKNOWLEDGE THAT CHAMP RACING, LLC DESIGNED RACE COURSES ARE ON
PUBLIC ROADS AND ARE SUBJECT TO THE RISKS AND DANGERS OF VEHICULAR TRAFFIC. SUCH RISKS INCLUDE
BUT ARE NOT LIMITED TO CONTACT/COLLISIONS WITH MOTOR VEHICLES, poles, signs, etc. Therefore, in
consideration of this entry, I, for myself, my heirs and executors waive, and release any and all rights
and claims AND FURTHER COVENANT AND AGREE NOT TO SUE OR HOLD NEGLIGENT ANY ENTITIES ASSOCIATED
WITH THIS EVENT. Such entities include, but are not limited to: CHAMP Racing, LLC,
event sponsors, race directors and volunteers, or any government or city officials or municipalities
in which the said event is located. I attest and certify that I, or my child, is/am physically fit and sufficiently
prepared to endure the said distance of this event. I, or my child, have/has not been advised
against participating by a qualified health professional.
________________________________________________________
Signature
________________________________________________________
Parent Signature (if entrant is under 18)
_____________________
Date
Be sure to mail-in entry form to the correct REGISTRATION address.
Event Name: ____________________________________________ Event Date: _____________
Participant Name: _______________________________________ Age as of Race Day _______ Birth date _____/______/________
________ Check here for Male 200+ Category
For XTERRA ONE ONLY: Age as of 12.31.08 __________ Would you like to compete in the Challenged Athlete Division? ______ (check)
XTERRA I.D.# __________________________________ USAT # (for XTERRA ONE) ____________________________
For SummiTriathlon ONLY: Check Here for OPEN/ELITEDivision ________
Address: _______________________________________________________________
City: ______________________________________ State: _______ Zip: ________________________
E-mail: ____________________________________ Male / Female (circle)
Phone: ( ________ ) ____________ - _________________________
T-shirt: (CIRCLE) Small Medium Large XL XXL
Be sure to mail-in entry form to the correct registration address.
FEE TABLE:
READ CAREFULLY BEFORE SIGNING THE RACE DISCLAIMER:
I understand that the sport of RUNNING, DUATHLON, and/or TRIATHLON, which
involves the sports of swimming, biking, and running are an extreme test of my, or my child's, physical and mental limits
and carries the potential for serious risks. I agree,attest and certify that by signing this registration
form, I WAIVE, RELEASE, AND FOREVER DISCHARGE FROM ANY AND ALL RISKS, CLAIMS,
LOSSES, OR LIABILITIES, WHICH OCCUR TO ME, OR MY CHILD, AS A RESULT OF MY/CHILD'S
PARTICIPATION IN THIS EVENT. SUCH RISKS, CLAIMS, LOSSES, OR LIABILITIES INCLUDE,
BUT ARE NOT LIMITED TO:death, injury, partial or permenant disability ordismemberment,
property loss and/or damage, medical and hospital bills, attorney fees and court/litigation expenses, theft of any items,
or any aforementioned claim, loss, or liability as a result of traveling to and from any and all CHAMP Racing, LLC directed
events. I assume, acknowledge, and are aware of additional dangers and risks associated with this event.
Such additional risks include but are not limited to falls, contact with other participants/volunteers,
effects of weather including heat, cold, and/or humidity, road/pavement conditions including
but not limited to potholes, curbs, gravel, dirt, tree/environmental debris, independent
construction equipment, surrounding natural environmental hazards, any hazard associated
or posed by other participants, spectators, non-participating pedestrians/joggers, or volunteers,
any hazards associated with equipment for event maintenance, control, organization, and safety
including, but are not limited to directions signs, post, cones, banners/flags, and bike racks.
I FURTHER UNDERSTAND AND ACKNOWLEDGE THAT CHAMP RACING, LLC DESIGNED RACE COURSES ARE ON
PUBLIC ROADS AND ARE SUBJECT TO THE RISKS AND DANGERS OF VEHICULAR TRAFFIC. SUCH RISKS INCLUDE
BUT ARE NOT LIMITED TO CONTACT/COLLISIONS WITH MOTOR VEHICLES, poles, signs, etc. Therefore, in
consideration of this entry, I, for myself, my heirs and executors waive, and release any and all rights
and claims AND FURTHER COVENANT AND AGREE NOT TO SUE OR HOLD NEGLIGENT ANY ENTITIES ASSOCIATED
WITH THIS EVENT. Such entities include, but are not limited to: CHAMP Racing, LLC,
event sponsors, race directors and volunteers, or any government or city officials or municipalities
in which the said event is located. I attest and certify that I, or my child, is/am physically fit and sufficiently
prepared to endure the said distance of this event. I, or my child, have/has not been advised
against participating by a qualified health professional.
________________________________________________________
Signature
________________________________________________________
Parent Signature (if entrant is under 18)
_____________________
Date
Be sure to mail-in entry form to the correct REGISTRATION address.
Printable Registration Form Procedures:
1. Print-out the following registration page.
2. Be sure to include the correct event/race.
3. Complete the information below and SIGN & DATE FORM.
4. Locate the event on the Fee Table and remit the applied registration fee.
3. Mail-in Form with entry fee to proper registration mailing address.
PLEASE NOTE THE "CHECKS PAYABLE" RECIPIENT.
1. Print-out the following registration page.
2. Be sure to include the correct event/race.
3. Complete the information below and SIGN & DATE FORM.
4. Locate the event on the Fee Table and remit the applied registration fee.
3. Mail-in Form with entry fee to proper registration mailing address.
PLEASE NOTE THE "CHECKS PAYABLE" RECIPIENT.
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CHAMP Racing Nation
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