Apple Kid Duathlon ENTRY FORM Please complete an Entry Form for each participant. (type or write clearly)
First Name ___________________________________________
Last Name __________________________________________
Street Address _______________________________________
City _______________________ State ____ Zip___________
Phone __(__________)_________________________________
Email _________________________________________
Parent/Guardian Name__________________________________ |
Age on 12/31/10 (race age) ________________
Circle One:
1. Race Ages 7-10 , ¼ Mile Run, 3 ½ Mile Bike, ¼ Mile Run
2. Race Ages 11-14 , ½ Mile Run, 7 Mile Bike, ½ Mile Run
USAT Membership Number_________________________
(USAT membership number must be provided or the application is not valid and will be returned – no exceptions.)
Gender _________Male _________Female
Tee Shirt Size (pre-registrations are guaranteed a tee shirt)
(circle one)
Child M L XL
Adult S M L
Make all checks payable to Sartell Apple Kids.
Waiver: In consideration of acceptance of my entry, I the undersigned, intending to be legally bound for myself, my heirs, executors, and administrators, do hereby release the Sartell Apple Kids, Apple Events, City of Sartell and any and all sponsors and assigns from any and all liability arising from illness or injury I may suffer as a result of my participation in this event. I attest and verify that I am physically fit and have successfully trained for the completion of this event. I am further aware that the course will be run on public property, which is not entirely closed to traffic. I have read the foregoing and certify my agreement by my signature below. No Pets or Skateboards, please.
Signature
____________________________________________
Parent /guardian signature, if applicant is under 18 years of age.
Registration Print out, complete and mail the registration
form to: (checks payable to Sartell Apple Kids)
Sartell Apple Kids
PO Box 146
Sartell, MN 56377