TRI-Umph Today Coaching
Welcome
Endurance Coaching
PROGRAMS / CLASSES
Adult Swimming
Cycling Classes
Youth Summer Swim Programs
Youth Running Club
T4 Youth Triathlon Team
2023 Race Schedule
Mandi Kowal
Coaching Background
Athletic Background
Contact Me
Youth Development Swim Squad
T4 Teen Registration
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Indicates required field
Name of the Athlete
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First
Last
Birthdate
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School
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USAT Membership Number
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USAT Memb. Expir. Date
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Name of Parent/Guardian
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First
Last
Name of Parent/Guardian
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First
Last
Primary Email Address
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2nd Email Address
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Mobile
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2nd Mobile
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Home Address
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Line 1
Line 2
City
State
Zip Code
Country
Special Needs
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Allergies
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Emergency Contact
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First
Last
Emergency Contact Phone Number
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Primary Doctor
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First
Last
Doctor's Phone Number
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Emergency Medical Care Release
In the event of an emergency involving my child and if the coaches cannot contact me, I hereby authorize any needed emergency medical care. I agree to assume full responsibility for all medical expenses incurred and to hold harmless and release from liability any and all parties involved with this training program.
I have read and agree
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Electronic Signature of Parent/Guardian
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Date
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I have read and agree
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Electronic Signature of Parent/Guardian
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Date
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Use of Image Permission and Waiver and Release
In consideration of my participation with the T4 Team, on behalf of myself and the child/teenager participant, I hereby grant the staff, it's officers, directors, employees, consultants, agents and successors a royalty-free, irrevocable, worldwide right to reproduce my and the child's/teenagers participant's likeness or image by photograph, video and any other means, and to use, publish, reproduce and distribute my and the child participant's name, voice, likeness, image and biography in whole or in part, in any medium, for any purpose in any manner and at any time.
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