ENTRY FORM AND RELEASE

Katz JCC Kid's Triathlon

Sunday, June 8, 2008

1 pm

All participants Must Complete and sign this form.

Make checks payable to: Katz JCC

Send check & Entry Forms to:

Gene Bonetti; 1301 Springdale Rd..; Cherry Hill, NJ 08003

For more information please contact: Gene Bonetti at 856-424-4444 ext. 141

Child's Name ___________________________________________

Parent's Name __________________________________________

Street Address __________________________________________

City _______________________________ State ____ Zip Code _________

Phone ______________________________

Email ______________________________

Age ______ Sex ____ Shirt Size S __ M __ L __

Race fee: $ ___________

Emergency Contact and Phone Number ________________________________________________

Relase and Wavier ( All Entrants must sign )

I release the Katz JCC and all of its representatives from any and all claims for personal injury or property damage which may arise directly or indirectly from the Children's Triathlon. I understand and agree that my child's participation is voluntary and that my child is medically able to take part. I understand that wearing a protective bicycle helmet is required.

_______________________________________________________________ Parent/Guardian Signature ____________Date