To register electronically through active.com click HERE

or to register by mail, Copy and/or Print this page first, then fill in the blanks and mail to:      

Bountiful Triathlon.
240 Odell Lane
North Salt Lake, UT 84054
Make check payable to: Bountiful Triathlon. $40 for individual and $25 per relay team member.

MAIL ENTRY FORM WITH FEE BY AUG. 1

Bountiful Triathlon Registration Form       Saturday, August 14, 2010

First Name       __________________            Last Name       __________________
Age on Aug. 2010 _______________              Gender             __________________
Birth Date MM/DD/YY  ______________               Phone #     ______________________
Address           ______________________________________________________
City                  __________________   State  __________________
Email                ______________________________________________________

Circle desired T shirt size: XL, L, M, S (preshrunk)
Race entered (circle one)      Individual or Relay Team

For Relays: Name of partner # 1 _________________________ Age_____ Gender ______
For Relays: Name of partner # 2 _________________________ Age_____ Gender ______
If relay team, name of team ___________________________________________________

Mark one of the following:
I wish to be in my age group class   
Or
I wish to be in the following special class:          
Clydesdale (male over 200 lbs)  
Filly (female over 150 lbs)  

WAIVER. 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 of the risks of participating &/or volunteering in this event. I realize that liability may arise from negligence or carelessness on the part of the persons or entities being released, from dangerous or defective equipment or property owned, maintained or controlled by them or because of their possible liability without fault.
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 form will be used by the event holders, sponsors and organizers of the event in which I may participate, and that it will govern my actions and responsibilities at said events. 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 occur to me including my traveling to and from this event, THE FOLLOWING ENTITIES OR PERSONS: Bountiful Triathlon, City of Bountiful, Davis County, South Davis Recreation Center, City of Centerville, State of Utah Their directors, officers, employees, volunteers, representatives, and agents, the even holders, event sponsors, event volunteers; (B) Indemnify and Hold Harmless the entities or persons mentioned in this paragraph from any and all liabilities or claims made as a result of participation in this event, whether caused by the negligence of releases or otherwise.
I hereby consent to receive medical treatment that may be deemed advisable in the event of injury, accident and/or illness during this event. I understand that at this event or related activities, 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 assigns. The Accident Waiver and Release of Liability 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 it’s content.
Signature (by parent or guardian if participant is under 18): _________________________________________