Wufoo

Applicant's Name * First Last
E-mail Address *
Mobile Phone Number * ### - ### - ####
Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Date of Birth * MM / DD / YYYY
What is your age group *
Male Female
Emergency Contact Name *
Emergency Contact Phone Number * ### - ### - ####
What distance races have you completed. Check all boxes that apply.
Spint Triathlon 10K Olympic Triathlon Half Marathon Half Iroman Full Marathon Full Ironman None of the above
What races are you training for this season?
Do you have any medical conditions or are you taking any medications that the ATC coaching staff should know about? If yes, please give details. If no, please state "none". *
WAIVER/RELEASE OF LIABILITY & CLAIMS
In consideration of acceptance by the Atlanta Triathlon Club of my application for entry into the Atlanta Triathlon Club’s triathlon training program (“Training Program”), & other good and valuable consideration relating to the Training Program, the receipt & sufficiency of which is hereby acknowledged; the undersigned (hereinafter “I”) represent & agrees as follows: I acknowledge & agree that The Atlanta Triathlon Club (ATC), The City of Atlanta, ATC staff & coaches, Triathlon Coaching Services LLC, USAT, USAT&F, affiliates, & their respective employees, independent contractors, agents, representatives, volunteers, sponsors, successors & assigns (hereinafter “The Atlanta Triathlon Club Parties”) cannot assure my safety during participation in the Training Program & that participation in the Training Program is a potentially hazardous activity & I assume ALL risks associated with participation in the Training Program, including but not limited to any running, walking, cycling, and/or swimming related injury; falls; traffic; effects of weather, including high heat, humidity & pollution; terrain; accidents, hazards, contact with other participants; all such risks being known & appreciated by me.

For myself & for my personal representatives, heirs, next of kin, executors, administrators, successors & assignees; I hereby agree, release, waive & forever discharge The Atlanta Triathlon Club Parties from any & all liability, & hold harmless & waive any & all claims, demands, damages, costs, expenses, actions & causes of action which might be stated against, whether in law or equity, as a result of any injury, including death, any loss or any damage to my person or property, howsoever caused, arising out of, by reason of, or during my travel to or from, attendance at or participation in the Training Program, whether as a spectator, participant or otherwise (all of the foregoing referred to hereafter as the “Claims”) whether or not the claims result from my following any program of diet and/or exercise on the recommendation of any of the Atlanta Triathlon Club Parties, whether such claims arise out of events prior to, associated with, during or subsequent to said attendance or participation in the Training Program, even if such claims were caused by, contributed to or occasioned by the negligence, fault or other conduct, whether foreseen or unforeseen, of the Atlanta Triathlon Club Parties.

The Atlanta Triathlon Club will assume that the undersigned is in good health and does not suffer from any health issue, illness or medical condition that could be triggered or aggravated by any exercise program recommended by Atlanta Triathlon Club Parties. To the extent that the undersigned is aware of any personal health issues, illnesses or medical conditions, the undersigned must disclose them in detail in writing.

I agree to indemnify & hold the Atlanta Triathlon Club Parties harmless from any & all liability, expense, loss & damage, & to provide a defense or to reimburse any cost that the Atlanta Triathlon Club Parties may incur if providing its own defense (including but not limited to reasonable attorneys fees & costs) in connection with any claims against the Atlanta Triathlon Club Parties. I further agree that the Atlanta Triathlon Club Parties may subsequently use for publicity & promotional purposes my name, likeness, photograph, videotape &/or any other recording of my participation in the Training Program. I acknowledge & understand that registration fees are non-refundable. I consent to & permit emergency treatment, medical or otherwise, in the event of illness or injury to myself & I further release the Atlanta Triathlon Club Parties from any claim whatsoever on account of first aid, treatment or service rendered me during my participation in the Training Program.

I acknowledge & understand that training sessions may be cancelled due to inclement weather and/or other unforeseeable circumstances. Those training sessions will not be rescheduled and a refund will not be given for those sessions.

I understand that at Atlanta Triathlon Club discretion, my membership in the Training Program may be denied or terminated at any time, for any reason, with no refund. I hereby affirm that I am eighteen years of age or older & I realize that above representations are contractual & not mere recital.

I HAVE CAREFULLY READ THE RELEASE ABOVE & HAVE FULLY INFORMED MYSELF OF & UNDERSTAND ITS CONTENTS & SIGN IT OF FREE WILL WITH FULL KNOWLEDGE OF ITS SIGNIFICANCE.

Electronic Signature * First Last
Today's Date * MM / DD / YYYY
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