Firecracker Kids Triathlon Waiver, Release and Indemnification

Firecracker Kids Triathlon
Waiver, Release and Indemnification Form
I hereby release Run-N-Tri Company, Ticking Tri Bombs, eFitness and Wellness, the city of Biloxi, the
event directors, Law Enforcement Agencies, and other Public Entities providing support for the event,
sponsors, all promoters, all race coordinators, volunteers, and all person or entities associated with this
event of all liability related to injuries or accidents which may occur as a result of participation in the
Firecracker Kids Triathlon.
I hereby agree to comply with all the rules and regulations and event instructions of the Firecracker
Kids Triathlon and its coordinators.
I hereby represent that the PARTICIPANT is physically capable of participating in the event, that the
PARTICIPANT’s bicycle and other equipment used to participate in the event are in working condition
and that the PARTICIPANT will use a helmet and conduct themselves in a safe and prudent manner
while participating in the event.
I hereby acknowledge that there are always certain risks associated with any physical activity. I
understand the risks and declare the PARTICIPANT listed below to be physically sound and capable to
participate in the Firecracker Kids Triathlon.
I hereby consent to receive or for the PARTICPANT to receive medical treatment which may be deemed
advisable in the event of injury, accident or illness during the Firecracker Kids Triathlon event. No
warranty as to the quality of medical care is be made.
I hereby acknowledge that I have sole responsibility for the PARTICIPANT’S personal possessions and
athletic equipment during the Firecracker Kids Triathlon event, and its related activities.
I hereby permit and authorize the free use and publishing of my or the PARTICIPANT’S name, image
and picture in websites, broadcasts, telecasts and the press as they pertain to the Firecracker Kids
Triathlon event.
I hereby absolve and hold harmless all and any parties or entities associated with Firecracker Kids
Triathlon from any damage I or the PARTICIPANT may sustain because of any breach of these
representations.
Participant Name (Print):_______________________________________________________
(Signature):_____________________________________________________
(Date):______________________________________________________
PARTICIPANTS UNDER 18 ARE REQUIRED TO HAVE A PARENT/GUARDIAN
SIGNATURE.
Parent/Guardian Name (Print):___________________________________________________
(Signature):_____________________________________________________
(Date):______________________________________________________