GREATER KNOXVILLE TRIATHLON CLUB
MEMBERSHIP FORM
Name _________________________________________
Address ______________________________________________
City ________________________ State _______ Zip __________
Home (______) _____________Work (______) ______________
E-mail address ________________________________________
Membership is calendar year
$30 for 2 years
Family $25 for 1 year
$40 for 2 years
Make checks payable to GKTC and mail to:
Doug Dunn, Treasurer
1192 Winding Way Dr
Knoxville TN 37923
Applicant must also sign the attached release form.
Thank you for your support of the Greater Knoxville
Triathlon Club!!!
Visit our website at www.knoxtri.com
Applicant
Must sign this release form.
Greater
Knoxville Triathlon Club – Release and Hold Harmless
I,
________________________________, acknowledge that training for, racing in
and/or, volunteering for running, biking, swimming and multi-sport events are
potentially hazardous activities. I further acknowledge that running, biking,
swimming and multi-sport events are extreme tests of a person’s physical and
mental limits and carries with it the potential for death, serious injury, and
property loss. I HEREBY ASSUME THE RISKS OF PARTICIPATING IN
ALL CLUB FUNCTIONS. I certify that I am physically fit, have sufficiently trained for
participation in these events and have not been advised otherwise by a
qualified medical person. I acknowledge that my statements on this RELEASE
AND HOLD HARMLESS are being accepted by the GREATER KNOXVILLE TRIATHLON
CLUB permitting me to participate in organized club functions. I hereby
take the following action for myself, my executors, administrators, heirs, next
of kin, successors and assigns a.) I AGREE to abide by the Competitive Rules
adopted by USA Triathlon, including the Medical Control Rules, as they may be amended
from time to time, and I acknowledge that my Club membership may be revoked or
suspended for
violation of
the competitive rules; b.) I WAIVE, RELEASE, ANDDISCHARGE from any and all
claims or liabilities for an organized Club function, THE
FOLLOWING PERSONS OR ENTITIES:
GREATER
KNOXVILLE TRIATHLON CLUB, USA Triathlon chartered Clubs, Club sponsors,
volunteers,
and the officers, directors, employees, representatives and agents of any of
the above; c) I AGREE NOT TO SUE any of the persons or entities
mentioned above for any of the claims or liabilities that I have waived,
released or discharges herein; and d.) I INDEMNIFY AND HOLD HARMLESS the persons
or entries mentioned above from any claims made or liabilities assessed against
them as a result of my actions during an organized Club function.
I HEREBY
AFFIRM THAT I AM EIGHTEEN (18) YEARS OF AGE OR OLDER (if under 18 a parent or
guardian must also sign below). I HAVE READ THIS DOCUMENT, AND I UNDERSTAND AND
AGREE WITH ITS CONTENTS.
SIGNATURE
___________________________________ DATE ___________________
As the
natural or legal guardian of the minor named above, I hereby bind myself, the
minor and our executors, administrators, heirs, next of kin, successors and
assigns to the terms of the foregoing RELEASE AND HOLD HARMLESS. I
represent that I have the legal capacity and authority to act for and on behalf
of the minor named above and I agree to indemnify and hold harmless the persons
or entities mentioned in the foregoing RELEASE AND HOLD HARMLESS for any
claims made or liabilities assessed against them as a result of any
insufficiency of my legal capacity or authority to act for and on behalf o the
minor in the execution of the forgoing RELEASE AND HOLD HARMLESS or in the execution
of the Consent.
PARENT/GUARDIAN
SIGNATURE ______________________________ DATE _____________