HillTop Training Triathlon Clinic

Application and Waiver

Date: ____________________
Last Name__________________________ First Name_________________ MI_____
Street Address_______________________________________________________
City_____________________________ State_____ Zip________
Birth Date_____________ Home Phone (___) __________
Work Phone (____) ______________
E-mail Address _______________________
Are you a USAT Member?_______
EMERGENCY INFORMATION:
In case of emergency, please notify:
Name ___________________________________
Relationship to you _______________________________
Address______________________________________________________________
Telephone __________________________
$249 includes 16 week plan and all seminars, clinics and practices.
Paid ( ) Date: _________________

Make checks payable to: HillTop Training, LLC
Mail to: Marnie Lawler
8 Lufkin Point Road
Essex, MA 01929

 

General:
Do you have any injuries? What and when were they treated (if it was treated) and what are you doing currently to address the injury? Have you seen a doctor? What did the doctor recommend?

What are your short term (16 week) goals for this clinic? (i.e. to finish, to improve a past performance, to jump start a marathon training plan, to learn how to cross-train effectively.)

What are your long term goals? For the year, more than one year away?

Have you signed up for the Gloucester Triathlon? If not, are you planning to? Or, do you have other races in mind, which one(s)?

What is your background in Triathlon (swim/bike/run)? Athletics in general? How much do you currently run per day/per week? Bike? Swim?

With what type of strength and conditioning programs have you been involved (past or present)? When was the last time you consistently followed a resistance program?

HillTop Training’s Triathlon Program Waiver

READ THIS DOCUMENT (THE “WAIVER AGREEMENT”) CAREFULLY BEFORE SIGNING. THIS WAIVER AGREEMENT WILL AFFECT YOUR LEGAL RIGHTS AND WILL LIMIT OR ELIMINATE YOUR ABILITY TO BRING A FUTURE LAWSUIT.
I understand and acknowledge that I am legally agreeing to the statements in the following paragraphs of this Waiver Agreement by affixing my signature below and that these statements are being accepted by HillTop Training in consideration for allowing me to participate in any HillTop Training ; and I
further understand and acknowledge that my statements are being relied upon by the coaches for HillTop Training and other parties defined below as the “Released Parties.”
1. I acknowledge that running. Biking, swimming, triathlon, duathlon, or other multi-sport clinic or Event (hereinafter “Event”) is an extreme test of a person’s physical and mental limits and carries with it the potential for death, serious injury, and property damage. I acknowledge and agree that it is my responsibility to determine whether I am sufficiently fit and healthy enough to safely participate in an Event, and I attest and certify that I am or will be sufficiently fit and physically trained to participate in any Event, which I elect to enter. I have no physical or medical condition, which would endanger me or another individual if I participate in any Event, or would interfere with my ability to safely participate in any Event. I accept responsibility for the condition and adequacy of my equipment and my conduct in connection with any Event. I understand and acknowledge the dangers associated with the consumption of alcohol and/or drugs before, during and after any Event and I recognize that consumption of alcohol and/or drugs might impair my judgment and/or motor skills. I assume full responsibility for any injury, loss or damage associated with my consumption of alcohol and/or drugs.
2. On behalf of myself, my executors, administrators, heirs, next of kin, successors and assigns, and anyone else who might sue on my behalf, I HEREBY WAIVE, RELEASE, and FOREVER DISCHARGE HillTop Training, all sponsors, producers, staff, administrators, organizers (including race directors), volunteers, all other persons or entities involved with an Event, states, cities, towns, and other governmental bodies and locations in which an Event or portions of an Event takes place, and the officers, directors, employees, agents, insurers, other participants and representatives of all of the above (collectively, the “Released Parties”), from any and all claims, causes of action, damages, losses (economic and non-economic), and liabilities of every kind (collectively “Claims”), for death, personal injury, or property damage, which may arise out of, result from, or relate to my participation in, or my traveling to or from, any HillTop Training Event, including but not limited to any Claims for theft, damage to any equipment, negligence, partial or permanent disability, Claims relating to the provision of first aid, medical care, medical treatment, or medical decisions (at an Event site or elsewhere), and any Claims for medical or hospital expenses.
3. I acknowledge and ASSUME ALL OF THE RISKS and aspects of an Event. I acknowledge that running, bicycling, swimming and other portions of an Event are inherently dangerous and I understand that I will be participating in an Event at my own risk, that I am responsible for the risk of participation in an Event, and that I am waiving and releasing my legal rights to sue for any injury or damages arising out of or resulting from my participation in an Event. I further understand that any injury or damages incurred may be the result of negligence, omission or carelessness by the Released Parties.
4. I FURTHER COVENANT and AGREE NOT TO SUE any of the Released Parties for any of the Claims that I have waived, released, or discharged herein. I AGREE TO INDEMNIFY and HOLD HARMLESS the Released Parties from any and all expenses incurred, Claims made, or liabilities assessed against them, including but not limited to attorneys’ fees and litigation expenses, arising out of or resulting from, directly or indirectly, in whole or in part, my breach or failure to abide by any part of this Waiver Agreement.
5. I AGREE that prior to participating in an Event I will inspect the race course, facilities, equipment, and areas to be used, and if I believe or become aware that any are unsafe, I will immediately advise the HillTop Training Coach. I FURTHER GRANT to Event organizers, and their licensees the right, permission, and authority to use my name, voice, picture, or photograph, in any broadcast, telecast, commercial advertisement, promotion, or other account of an Event, and I WAIVE any rights to future compensation to which I might otherwise have been entitled for such use.
6. The parent or legal guardian who signs the Waiver Agreement on behalf of a minor, incapacitated and/or mentally challenged person (hereinafter “Said Person”), hereby acknowledges that he or she has the legal capacity and authority to act on behalf of Said Person to legally bind Said Person to the Waiver Agreement. The parent or legal guardian who signs the Waiver Agreement agrees to indemnify and hold harmless the Released Parties for any expenses incurred, Claims made, or liabilities assessed against them, as a result of any insufficiency of legal capacity or authority to act on behalf of Said Person in the execution of the Waiver Agreement.
7. If any provision of this Waiver Agreement shall be unlawful, void, or for any reason unenforceable, then that provision shall be deemed severable from this Waiver Agreement and shall not affect the validity and enforceability of any remaining provisions.

(Athlete or Participant)

Print Name:_____________________Signature:______________________Date:____

Age: Date of Birth:_______

(Parent or Legal Guardian for Persons under Eighteen (18) Years of Age or Legal guardian of incapacitated and/or mentally challenged person)

Name of Guardian: Signature: ___________________________________Date:
Relationship to Minor or incapacitated and/or mentally challenged person: