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PPP Relay
Print Form
Sponsor - TAO

Name: ____________________________________________________________________
Address: ____________________________________________________________________
Email: ____________________________________________________________________
T-Shirt Size: (S) (M) (L) (XL)   _______         Age on race day:_______________
Category: (Team) (Solo Female) (Solo Male)
(Junior Team) (Junior Female) (Junior Male)
(Masters Team) (Masters Female) (Masters Male)
Team Name: ___________________________________________________________________
Triathlon NS Number: ___________________________________________________________________

In consideration of my entry, I acknowledge and understand that this event is physically challenging and I am physically able to participate in such an event. Nonetheless, I, my successors or heirs shall not hold the organizers or volunteers or the Waverly Sports Park owners responsible for any injury or loss of any kind that may occur as a result of my participation in, or viewing of this event. I certify that I am over the age of 18 and understand clearly my release of liability that I am signing, and the potential risk that I am taking.

Signature:___________________________     Date:___________________________

I, individually as parent and guardian of the above named minor, do hereby give my consent of his/her participation in said event, and further release the organizers from all claims, demands of charges on account of any and all injuries to persons or property that may result by virtue of said minors, participation in said event.

Parent's Signature: _____________________________________

Checks Payable To: Mail To: Drop Off Or Mail To:
Bruce Duffy Bruce Duffy The Adventure Outfitters
7 Lakeview Rd. 182 Chain Lake Dr.
Lakeview, N.S. B4C 4C6 Halifax N.S. B3S 1C5

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