2023 Keiki Triathlon Summer Fun Form & Media Release

Keiki Triathlon Summer Fun 2023

with Raul Boca and Mariane Uehara
Parent/Guardian Name

First NameLast Name
Parent/Guardian Email
example@example.com
Phone Number (Best number to reach in case of emergency)
Please enter a valid phone number.
Phone Number (Second best number to reach in case of emergency)
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Keiki 1 - Name

First NameLast Name
Keiki 1 - Birthday

MonthDayYear
Date
Keiki 1 - Swim Level

never swam without floatdon't put face in the watercomfortable in the watercan swim
Keiki 1 - Bike Level

training wheelbalance bikecan ride
Keiki 1 - T-shirt Size

SmallMediumLarge
Keiki 2 - Name

First NameLast Name
Keiki 2 - Birthday

MonthDayYear
Date
Keiki 2 - Swim Level

never swam without floatdon't put face in the watercomfortable in the watercan swim
Keiki 2 - Bike Level

training wheelbalance bikecan ride
Keiki 2 - T-shirt Size

SmallMediumLarge
Keiki 3 - Name

First NameLast Name
Keiki 3 - Birthday

MonthDayYear
Date
Keiki 3 - Swim Level

never swam without floatdon't put face in the watercomfortable in the watercan swim
Keiki 3 - Bike Level

training wheelbalance bikecan ride
Keiki 3 - T-shirt Size

SmallMediumLarge
Media Consent and Release Form

I hereby give Boca Hawaii and Free Lifestyle and its representatives and authorized media organizations permission to print, photograph, and record my child for use in audio, video, film, or any other electronic, digital, and printed media.

I certify that I have read the Media Consent and Release Liability statement and fully understand its terms and conditions.

I agree that this program is sanctioned by USAT.
Date

MonthDayYear
Date
Signature

Clear
TO RESERVE YOUR KEIKI(S) SPOT, PAYMENT NEED TO BE MADE BY JUNE 15, 2023

$275 per keiki (second and third keikis $25 off ) - USAT insurance included

Check payable to Boca Hawaii LLC - Mail check to 330 Cooke St - 96813 - Honolulu - HI.

Or pay by credit card at Boca Hawaii - call 808.591.9839 or visit the store - 330 Cooke St.
Should be Empty:

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Keiki Triathlon Summer Fun 2023