4th Anual Lookout Mountain Off Road Triathlon

Team Member #1
Name:   
Adress:  Street/City/St/Zip:
Phone:    Date of Birth: Sex: Male Female
Email Address: T-shirt size: Medium Large X-Large
Emergency Name/Phone:
Team Member #2
Name:   
Adress:  Street/City/St/Zip:
Phone:    Date of Birth: Sex: Male Female
Email Address: T-shirt size: Medium Large X-Large
Emergency Name/Phone:
Team Information:
Team Name: Team Class: Co-Ed |    Male |    Female

All riders will be required to wear helmets!
RELEASE Please read carefully and sign.
      I understand that bicycle riding is potentially hazardous and involves a certain degree of risk that may result in injury or death.  In consideration of the benefits to be derived after carefully considering the risk involved, I am voluntarily entering into these activities with knowledge of such danger recognizing that participation in The Way Home’s Lookout Mountain Off Road Triathlon is voluntary.  I hereby accept any risk of injury or death.  In consideration of being permitted to participate in this activity, I, for myself, my spouse, legal representative, heirs, and assigns, hereby release, waive, indemnify and hold harmless, and discharge club, its trip leaders, coordinators, sponsors, representatives, officers, directors, employees, volunteers and any other person associated with such activity, from all liability to me my spouse, legal representative, heirs, and assigns, for any and all damage, any claim for damages resulting there from, on account of injury to my personal property, or my death, whether caused by negligence of Club or otherwise while I am taking part in this activity.  I understand that bicycle riding is physically strenuous and I should not participate in a club event including, but not limited to, falls, contact with other participants, the effects of weather on trail or road conditions, traffic, and certify that I have read and understand the importance and provisions, and the release of liability. 
 Signature ___________________________________________ Date

Signature of Parent or Guardian if under 18 ____________________________Date
(Must be accompanied by adult if under age 16.)

Please fill out and print the form, read & sign the release.
Make checks payable to: The Way Home
Send to:
The Way Home
attn: century
PO Box 680145
Fort Payne, Al 35968