Dysart Triathlon Registration Form

Participant Information *

First NameLast Name

Age*

Date of Birth

Medical Conditions or Allergies

Yes or No Please Specify

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Please enter a valid phone number.

Email*

example@example.com

Race Entry Type*

SoloTeam . Please note that all team members must complete separate registration form

Team Name and Your Role - Swimmer, Cyclist or Runner

Race Catergory*

Cool Kids Dash: Ages 3 plus with Parent Support if needed. 15M Swim, 200M Bike & 100M RunRaising Stars: 30M Swim, 400M Bike & 200M RunTRI for Fun: 50M Swim, 2KM Bike & 1KM RunTRI it Out: 200M Swim, 4KM Bike & 2km RunFit and Fierce: 400M Swim, 6KM Bike & 5KM RunBonded by GRIT: 750M Swim, 6KM Bike & 10KM RunSplash and Dash: 400M Swim & 5KM RunSplash and Dash: 400M Swim & 10KM RunSplash and Dash Express: 200M Swim & 5KM Run

Terms And Conditions of Entry

In registering for the 2025 Dysart community triathlon I agree to the following terms and conditions

1.I the undersigned in consideration of, and as a condition acceptance of my entry in the Dysart Community Triathlon (the event) for myself, I hereby waive all and any claim, right or cause of action which I might otherwise have arising out of my death or injury, damage or loss of any description whatsoever I may suffer or sustain the course of, or consequent upon my entry or participation in the Event.

2. I am in good physical health and am participating in the Dysart Community Triathlon at my own risk

3. Neither the organisers, nor its councillors, employees, agents, contractors, sponsors volunteers shall be liable for any loss or damage whatsoever caused to me arising out of or contributed to by my participation in the event, including any loss or damage that may arise out of negligence of any of the parties as mentioned above

4.If an entrant is under 18, I certify that I am the parent/legal guardian of and he/she has my consent to participate in the Dysart Community Triathlon

5.This waiver, release and discharge shall be (and operate separately) in favour of all persons, corporations and bodies involved, or otherwise engaged in promotion or staging the event and each of their servants, agents, representatives and officers

6.refunds will be provided with medical certifcate or if the event is cancelled due to severe weather .

7. All medical information must be declared. The medical questions have been answered truthfully and I acknowledge that I will seek medical advice prior to participating in the event if I have suffered or I am suffering from a medical condition or injury

8.Consent to medical treatment. I consent to receiving medical treatment that the event organisers or their authorised representatives consider necessary or desirable during or after the event.

9. I give permission for the free use of my name, voice or picture in any broadcast, telecast, advertising, promotion or other account of this event, including advertising and promotions for future Dysart Community Triathlons or Mana Sport and Leisure Events

10.I agree to read the event rules and regulations and conform to them

11. Privacy Statement. The organiser respects and values the privacy of all information that we collect about event participants. As the event organiser, we collect information about participants for the administration and conduct of the event. Information collected will be securely stored on our database. It will be disclosed to medical staff for delivering medical services and participant names to the Dysart Community centre for publishing results in the Dysart Diary. Participants information may also be used for generation of media stories with prior consent. By entering this event, you consent to your personal information being provided to the Dysart Community triathlon for administration and conduct of the event.

12.Age restrictions. Age restrictions apply to each course. You must be 3 years and over to complete the Cool Kids Dash , and you must be 11years and over to compete in the TRI it out course.

I have read, understand and agree to the terms and conditions of entry in the Dysart Triathlon*

YESNo

Name of Participant or Parent/Guardian if Participant is under 18yrs *

First NameLast Name

Signature*

Registration Fee Payment*

Child $12.50Adult $20

Direct Deposit details:

Account Name: Mana Sport and Leisure

Bank: Westpac

Account Number :396835

BSB:034-150

Reference: TRI & Name

Note. Mulitple entries per family can deposited as one payment