Printable Registration Form: Please Fill-out the form completely. ALL RELAY TEAM MEMBERS MUST COMPLETE EVENT FORM,
Event Name: _________________________________________________________________ Event Date: ____________________
Participant Name: _______________________________________ Age as of Race Day _______ Birth date _____/______/________
________ Check here for Male 200+ Category.
________ Check here for Athena Category.
________ Check here if RELAY. TEAM NAME: _________________________________________________________
________ Check here for XTERRA ONE "Challenged Athlete" Division.
________ Check here for XTERRA ONE DUATHLON Division.
________ Check here if you are a USAT Member. If yes, USAT Number _____________________________
________ Check here if you have an XTERRA ID Number. If yes, ID Number ____________________________
Address: _________________________________________________________________________________
City: ____________________________________________ State: _______ Zip: ________________________
E-mail: __________________________________________________ Male / Female (circle)
Phone: ( ________ ) ____________ - _________________________
Please list team/relay members: ____________________________ ________________________________
T-shirt/s: (CIRCLE) Small Medium Large XL
Be sure to mail-in entry form to the correct registration address.
FEE TABLE:
PLEASE NOTE THE EARLY & LATE REGISTRATION FEES AND DATES
READ CAREFULLY BEFORE SIGNING THE RACE DISCLAIMER: All relay team members MUST complete individual forms.
WARNING: READ CAREFULLY. THIS AGREEMENT INCLUDES A RELEASE OF LIABILITY AND WAIVER OF LEGAL RIGHTS AND DEPRIVES
YOU OF THE RIGHT TO SUE CHAMP RACING. DO NOT SIGN THIS AGREEMENT UNLESS YOU HAVE READ IT IN ITS
ENTIRETY.
I understand that the sport of RUNNING, DUATHLON, and/or TRIATHLON, which
involves the sports of swimming, mountain/road biking, and running are an extreme test of my, or my child's, physical and
mental limits and carries the potential for serious risks. I hereby agree that I am in good health and physically prepared to
particpate in this event. I agree that it is my sole responsibility to
determine whether I am sufficiently fit and healthy enough to participate in the Event.
I agree,attest and certify that by signing this registration
form, I WAIVE, RELEASE, AND FOREVER DISCHARGE FROM ANY AND ALL RISKS, CLAIMS,
LOSSES, OR LIABILITIES, WHICH OCCUR TO ME, OR MY CHILD, AS A RESULT OF MY/CHILD'S
PARTICIPATION IN THIS EVENT. SUCH RISKS, CLAIMS, LOSSES, OR LIABILITIES INCLUDE,
BUT ARE NOT LIMITED TO: death, injury, partial or permenant disability or dismemberment,
property loss and/or damage, medical and hospital bills, attorney fees and court/litigation expenses, theft of any items,
or any aforementioned claim, loss, or liability as a result of traveling to and from any and all CHAMP Racing, LLC directed
events. I assume, acknowledge, and are aware of additional dangers and risks associated with this event.
Such additional risks include but are not limited to falls, contact with other participants/volunteers,
effects of weather including heat, cold, and/or humidity, road/pavement conditions including
but not limited to potholes, curbs, gravel, dirt, tree/environmental debris, independent
construction equipment, surrounding natural environmental hazards, any hazard associated
or posed by other participants, spectators, non-participating pedestrians/joggers, or volunteers,
any hazards associated with equipment for event maintenance, control, organization, and safety
including, but are not limited to directions signs, post, cones, banners/flags, and bike racks.
I FURTHER UNDERSTAND AND ACKNOWLEDGE THAT CHAMP RACING, LLC DESIGNED RACE COURSES ARE ON
PUBLIC ROADS AND ARE SUBJECT TO THE RISKS AND DANGERS OF VEHICULAR TRAFFIC. SUCH RISKS INCLUDE BUT
ARE NOT LIMITED TO CONTACT/COLLISIONS WITH MOTOR VEHICLES, poles, signs, etc. Therefore, in consideration of
this entry, I, for myself, my heirs and executors waive, and release any and all rights
and claims AND FURTHER COVENANT AND AGREE NOT TO SUE OR HOLD NEGLIGENT ANY ENTITIES ASSOCIATED
WITH THIS EVENT. Such entities include, but are not limited to: CHAMP Racing, LLC,
event sponsors, race directors and volunteers, or any government or city officials or municipalities
in which the said event is located. I attest and certify that I, or my child, is/am physically fit and sufficiently
prepared to endure the said distance of this event. I, or my child, have/has not been advised
against participating by a qualified health professional. I also grant CHAMP Racing, LLC the permission to use my
photograph on promotional literature and CHAMP Racing website.
________________________________________________________
Signature
________________________________________________________
Parent Signature (if entrant is under 18)
_____________________
Date
Be sure to mail-in entry form to the correct REGISTRATION address.
Printable Registration Form Procedures:
1. Print-out the following registration page.
2. Be sure to include the correct event/race.
3. Complete the information below and SIGN & DATE FORM.
4. Locate the event on the Fee Table and remit the applied registration fee.
3. Mail-in Form with entry fee to proper registration mailing address.
PLEASE NOTE THE "CHECKS PAYABLE" RECIPIENT.
EVENT
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EARLY/PRE-REG FEE
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LATE/RACE-DAY FEE
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CHECKS PAYABLE TO:
MAILING ADDRESS
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ST. MARK FOR THE ARTS
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$15 5K/1 Mile
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$18 5K/1 Mile ( after May 24)
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PAYABLE TO: ST. MARK PARENT CLUB
ST. MARK SCHOOL ATTN: RUN FOR THE ARTS
15800 MONTROSE AVE.
CLEVELAND, OH 44111
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NEO TRIATHLON KICKOFF
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Early Reg until 6/10/10
$49
$70 Relays
|
Late Reg begins 6/11/10
$55
NO RACE DAY
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PAYABLE TO: CHAMP RACING
CHAMP RACING
P.O. BOX 2384
STREETSBORO, OH 44241
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SUMMITRIATHLON @ MUNROE
FALLS METROPARKS
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Early Reg until 6/22/10
$49
$70 Relays
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Late Reg begins 6/23/10
$55
NO RACE DAY
|
PAYABLE TO: CHAMP RACING
CHAMP RACING
P.O. BOX 2384
STREETSBORO, OH 44241
|
MILTONMAN TRIATHLONS
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Early Reg until 7/22/10
$58 Olympic
$48 Sprint
$80 Olympic Relay
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Late Reg begins 7/23/10
$68 Olympic
$55 Sprint
$80 Olympic Relay
NO RACE DAY
|
PAYABLE TO: CHAMP RACING
CHAMP RACING
P.O. BOX 2384
STREETSBORO, OH 44241
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NORTH SHORE BORDER WAR
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Early Reg until TBA
TBA
$80 All Relays
***ALL RELAY TEAM
MEMBERS MUST
COMPLETE INDIVIDUAL
FORM
|
Late Reg begins TBA
TBA
$80 All Relays
NO RACE DAY
|
PAYABLE TO: CHAMP RACING
CHAMP RACING
P.O. BOX 2384
STREETSBORO, OH 44241
|
XTERRA ONE
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TRIATHLON/DUATHLON
Early Reg until 7/9/10
$68 USAT Members
$78 USAT NonMembers
TRAIL RUN FEES
TBA
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TRIATHLON/DUATHLON
Registration on 7/10/10
$80 USAT Members
$90 USAT NonMembers
TRAIL RUN FEES
TBA
NO RACE DAY
|
PAYABLE TO: CHAMP RACING
CHAMP RACING
P.O. BOX 2384
STREETSBORO, OH 44241
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JOY FOUNDATION 5K
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$10 Walk
$15 5K
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$15 Walk (after August 9)
$20 5K (after August 9)
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PAYABLE TO: JOY FOUNDATION
CHAMP RACING
P.O. BOX 2384
STREETSBORO, OH 44241
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SOLON COMMUNITY FUN RUN
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TBA
|
|
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BCA EAGLE RUN
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TBA
|
|
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RUN WITH THE LAW
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TBA
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