Sunday, June 30, 2013 -- Uniontown, PA / Uniontown YMCA, One YMCA Lane
Uniontown YMCA Sprint Triathlon ENTRY FORM
RACE CONTACT: Bill Poninsky/Uniontown YMCA (phone) 724-438-2584 (email) billp@uniontownYMCA.org
Mail to: Bill Poninsky, Uniontown Area YMCA, One YMCA Lane, Uniontown, PA 15401
Checks payable to: Uniontown YMCA
Name: _____________________________________________________________________
Address: __________________________________________________________________
City/State/Zip: ___________________________________________________________
Phone: (__________________)________________________________________________
E-mail: ___________________________________________________________________
Age on Race Day:_____ // Birthdate:_____/______/___________
# of children for RaceCare (childcare):______ // Age(s)_______
Sex: Female___ / Male___ // Shirt Size: S___ M___ L___ XL___ XXL(add $2)___
Estimated Swim Time:________ // Est. Bike Time:________ // Est. Run Time:_________
Individual___ Male Relay___ Female Relay___ CoEd Relay___ Corporate Relay___
IF RELAY, Team Name: _______________________________________________________
*Team applications must be submitted together and each team member is required to complete and sign entry form!
WAIVER: In consideration of my entry being accepted in the Uniontown Triathlon, I, intending to be legally bound, as shown by my signature below do hereby, for myself, my heirs, executors, and assigns, waive, release and forever discharge any and all rights and claims for damages that I may have or which may hereafter accrue to me against the Uniontown Area YMCA Triathlon, Uniontown Area YMCA, timing service, PennDot, AND ALL sponsors. I understand the difficulty of this event and attest by my signature below that I am in good physical condition and also attest that I understand that everyone should consult a physician prior to any physical activity.
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Athlete Signature
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Date
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Signature of Parent or Guardian if Athlete under 18