Name
*
First Name
Last Name
Triple Decker- swim/bike/run Triathlon waiver and release
Email Address:
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of Birth:
*
-
Month
-
Day
Year
Date
Phone Number
*
Please enter a valid phone number.
Emergency Contact Name:
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Are you signed up for a triathlon this year? Which one ?
Do you suffer from any medical condition? If yes, please elaborate:
*
Do you believe you are in a good physical and mental health?
*
Do you own a wetsuit?
Do you own an Open Water Swim Buoy?
*
Have you done any triathlon distance races before?
*
Are you able to swim at least 1500 yards continuously?
*
Have you ever done an Open Water Swim before?
*
What was the longest Open Water Swim you have ever done? And when?
*
What do you hope to achieve from this mock race?
*
Please read carefully before you sign below:
Have you read and understood the waiver above?
*
Signature
Submit
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