Please leave this field empty.

First Name (required)

Last Name (required)

Middle Initial (required)

Email (required)

Street Address

City

State
AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareWashington DCFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennslyvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Postal Code (required)

Phone number (required)

USAT #

Gender (required)
MF

Age

Date of Birth (required): MM/DD/YYYY

Shirt Size
SMLXLXXL

Waiver and Release

I hereby assume the risks of participating in any Rock River Multisport (hereinafter referred to as "RRM") functions or events. I acknowledge that endurance events such as triathlons, swimming races, bicycle races, running races, or other club events are an extreme test of a person's physical and mental limits and carry with them the potential for death, serious injury, and/or property damage or loss. I certify that I am in good health and am physically fit. I have sufficiently trained for participation in such events and have not been otherwise advised by a qualified medical person; and that I do not suffer from any physical impairment which would limit my participation in any RRM athletic or social event. I acknowledge that my statements on this Waiver and Release from Liability are being accepted by RRM and are being relied upon by USA Triathlon, RRM, its organizers and administrators in permitting me to participate in RRM organized events and functions, I hereby irrevocably take the following action for myself, my executors, administrators, heirs, next of kin, successors and assigns: A) I AGREE to abide by the Competitive Rules adopted by USA Triathlon and any other governing body of the sport or event in which I am participating. I acknowledge that my membership in RRM may be revoked or suspended for violation of the competitive rules: B.) I WAIVE, RELEASE, AND DISCHARGE from any and all claims or liabilities for death, personal injury, psychological or emotional injury, property damage, theft, damages or losses of any kind, which arise out of or relate to my membership in RRM, my participation in, or my traveling to and from, any RRM athletic or social event, the following persons or entities: Rock River Multisport; RRM Members; RRM Sponsors; RRM Attorneys; Race or event volunteers; USA Triathlon; and the officers, directors, employees, representatives, and agents of any of the above; C.) I AGREE NOT TO SUE any of the persons or entities mentioned above for any of the claims or liabilities that I have waived, released, or discharged herein; D.) I AGREE TO INDEMNIFY, DEFEND, AND HOLD HARMLESS the persons or entities mentioned above from any and all damages, costs, and expenses of any kind, including attorney's fees and costs, that arise from or are related to my membership in Rock River Multisport, my participation in, or my traveling to and from, any RRM athletic or social event or function. E.) I FURTHER UNDERSTAND that the Rock River Multisport name and logo is the property of and is owned by Rock River Multisport, and I ACKNOWLEDGE AND UNDERSTAND that I am not authorized to use, wear, or display the RRM name or logo in connection with any illegal or prohibited activity or any activity that will result in any liability or damage. By signing below, I hereby agree that my name or photograph may be used in any marketing materials including newsletters, media kits, advertising, and the Rock River Multisport. I also grant permission for use of photographs of myself in RRM newsletters or other correspondence. The CLUB website, or promotional materials, and for submissions to newspaper articles and to RRM sponsors. In the event that a dispute arises between the undersigned and RRM with regard to any issue raised in this WRL, any RRM event or activity, or any alleged injury or damage incurred by the undersigned, the name shall be submitted in accordance with any state or local practice and procedure, to the Circuit Court of Winnebago County, IL. In executing the WRL, the undersigned hereby himself/herself to the jurisdiction of the Circuit Court of Winnebago County, Illinois, and agrees not to challenge the jurisdiction of that court in any such proceeding. Any dispute arising under this WRL or requiring interpretation of this WRL shall be governed by the law of the State of Illinois. I HEREBY AFFIRM THAT I AM EIGHTEEN (18) YEARS OF AGE OR OLDER, I HAVE READ THIS DOCUMENT, AND I UNDERSTAND ITS CONTENTS. If the undersigned is under eighteen (18) years of age, his/her parent or legal guardian must sign this WRL AND the additional release below.

I accept the Waiver and Release.