DATE: July 21, 2012 - 8:45 A.M.

LOCATION: Castle Rock Park, County Rd Z, Friendship, WI

DISTANCES: 1/4 mile swim, 16 mile bike, and 3 mile run

Registration Form - Please Print
This form may be duplicated.

Name:__________________________ Home Phone:____________

Street:__________________________ P.O. Box:_____________

City:____________________ State:______ Zip:____________

Email:______________________________

Birthdate:________ Sex:____

Select if Applicable

___Male/Clydesdale (200 lbs. +) or __ Female/Athena (150 lbs. +)


Ability Level: ____________________
(Elite - Experienced - Beginner)

Shirt Size: S_____ M_____ LG_____ XL_____ XXL_____ (if team please list all sizes)

TEAM INFORMATON

Team Name:____________________

Coed______Male______Female_____

Swimmer ________________________ Birth Date __________

Biker ___________________________ Birth Date ___________

Runner _________________________ Birth Date ___________


I hereby absolve and hold harmless the County of Adams, the Township of Quincy, the Adams County Sheriff's Department, the Adams County Highway Department, Curtis Ambulance Service, Moundview Memorial Hospital & Clinics, the Adams County Chamber of Commerce & Tourism, the Adams-Friendship Student Council, all sponsors and race official from any liability for any injury incurred by myself while participating in the Castle Rock Triathlon. I further provide that this consent and waiver applies to my heirs, executors and assignees. I attest and verify that I will participate in this event as a Triathlon entrant that I am physicall fit and have sufficently trained for the completion of this event and a licensed medical doctor has verified my physical condition. Further, I hereby grant full permission to any and all of the foregoing to use my name and any photographs, videotapes, motion pictures, recordings, or any other record of me participating in the event for any publicity and/or promotional purposes without obligation or liability law. I have read the entry information provided and certify my compliance by my signature below. I also understand entry fees I pay are non-refundable.

Signature:_____________________________________________

Parent/Guardian:_______________________________________

Please make checks payable to: Castle Rock Triathlon

Send completed registration to: Castle Rock Triathlon, P.O. Box 576, Adams, WI 53910

Castle Rock Triathlon Profits go to Community Non-profit Groups & Organizations

Early registration is strongly encouraged.

* Individual Registration postmarked by 7/9- $45.00
* Individual Registration postmakred 7/10-7/16 - $50.00
* Individual Registration postmarked after 7/16 - $75.00

* Team Registration postmarked by 7/9 - $70.00
* Team Registration postmakred 7/10-7/16 - $75.00
* Team Registration postmarked after 7/16 - $80.00

This year the race will be timed with ChampionChip Timing system. All athletes will be issued a timing chip. This chip must be worn on the ankle throughout the entire race. No chip, no time. Chips must be returned after the race or the athlete will be subject to a $35 fee.