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