PAIN Registration

Acknowledgment, Waiver, & Release From Liability

* Indicates required field

I acknowledge that participating in and training for triathlon, multisport, swimming, and/or running events is an extreme test 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 TRAINING FOR AND PARTICIPATING IN TRIATHLON, MULTISPORT, SWIMMING, AND/OR RUNNING EVENTS. I certify that I am physically fit, and have not been advised otherwise by a qualified medical person. I acknowledge that this Acknowledgment, Waiver, & Release From Liability ”AWRL” form will be used by TriVault Inc. “TriVault” and the sponsors and organizers of all TriVault activities. Activities being of a workout or low-key nature or a race format or just a social event. I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assign as follows: a) WAIVE, RELEASE, DISCHARGE, and AGREE NOT TO SUE, for any and all liability for my death, disability, personal injury, property damage, property theft, or action of any kind which may hereafter accrue to me as a result of participation in, or my traveling to or from a TriVault activity, THE FOLLOWING PERSONS OR ENTITIES: TriVault, event sponsors, race directors, event producers, event volunteers, and all cities, counties, districts and/or states in which said events may be staged or in which segments of said events may be run and its (their) officers, directors, employees, representatives and agents and volunteers; b) INDEMNIFY AND HOLD HARMLESS the persons or entities mentioned in the paragraph from any and all liabilities or claims made by individuals or entities as a result of my actions during TriVault activities or events. I realize that most TriVault activities are of a workout or social nature and no traffic control will be in place during the event or activity. I will be responsible for knowing and following all traffic laws while participating in, practicing for, or traveling to or from a TriVault event or activity. I hereby consent to receive treatment in the event of my injury, accident, and/or illness during any TriVault activity. I hereby grant TriVault permission to use my name and/or photograph in any and all of its publications, including website entries, without payment or any other consideration. BY ENTERING MY FIRST AND LAST NAME BELOW, I CERTIFY THAT I AM EIGHTEEN (18) YEARS OF AGE OR OLDER; I HAVE READ THE AWRL ABOVE; AND UNDERSTAND ITS CONTENTS. *

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Phone Number *

Gender *

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Birth Month *

Birth Day *

Birth Year *

Do you have allergies? If yes explain. *

Do you take any medication? If yes explain. *

Do you have any medical conditions? If yes explain. *

Do you have any injuries? If yes explain. *

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