Summer Youth Camp Registration Form - DOC - DOC by Fp05N61

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									                   2009 Spartan Triathlon Registration Form
PARTICIPANT INFORMATION

Last Name _____________________               First Name _____________________               Date of Birth ____________
Address _______________________               City _____________________ State ______                  Zip Code ________
Phone number _________________________                 E-mail ______________________________________
                                                                - email needed for heat information.


Emergency Contact _____________________                Emergency Contact Number _____________________

Male____ Female____ Age_______ SJSU Student_______ SJSU Faculty/Staff_______ Community_______


Team Name and Member____________________________________________________________________

Please estimate your laps/miles in 15 minutes: Swim Laps: ________ Bike Miles: ________ Run Miles: _______
                                                 Lane Priority: Shallow End______ Deep End_____

When: April 25th, 2009:                8:30am Check-in                   9:00am First Heat Begins
        Each leg of the race will consist of 15 minute intervals where the participants will go the distance to earn
         points in each area. Points will be allotted for each, swimming laps in a 25 yard pool, using a
         computerized mile marker for the stationary bikes on deck and counting laps running a loop around
         campus.
        Maximum 16 Participants in each heat: First come first served basis. Participants will be designated heat
         times as registration sheets come in. Approx Heat times: 9:00, 9:20, 9:40, 10:00, 10:20, 10:40, 11:00,
         11:20.
        If you need Information about your heat time, call the Aquatic Center 408-924-6341

PAYMENT INFORMATION
    □ SJSU Student with Valid ID card #_______________________________________; $10
    □ SJSU Faculty/Staff with Valid ID card: $15
    □ Community Members: $25
Cash ______Check______ (payable to Student Union, Inc)                  VISA______Mastercard______
Card No.________________________________________________ Exp Date____________________
Cardholder’s Name_____________________________Signature_____________________Date__________
              By Mail: Event Center/Aquatic                    By Fax: Credit Card Only
                        Attn: Rebecca Harper                        Attn: Rebecca Harper
                        290 South 7th Street                          408-924-6344
                        San Jose, CA 95192-0201

INDIVIDUAL CONTRACT
To the extent allowed by law, I _______________________ (Name), the undersigned or parent/legal guardian of the
individual named below, shall hold harmless, indemnify, and defend the Student Union of San Jose State University, San
Jose State University, the State of California, the Trustees of the California State University and their officers, employees,
volunteers and agents of each from any kind of loss, liability, expense, claim, costs, suits and damages directly or indirectly
arising from participation in the listed activity. The Student Union Inc. also reserves the right to remove participants from
any program at its sole discretion. I also understand that participation in any activity can cause severe injury or death and I
have taken care to enroll at the level to my/his/her physical abilities and/or medical conditions. I hereby grant permission to
the Student Union Inc. to take my photo while participating in the activities to use for publicity. One parent/guardian must
sign for all minors (under the age of 18.)

_______________________________________________________________________
Signature of participant or legal parent/guardian  Date


                                                                                                    FOR OFFICIAL USE ONLY:
                                                      Paid Fee:  Yes  No       Staff Initials: _____ Heat time:__________

								
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