Piney River Mini Triathlon Registration Form

Just fill out the information below, press the "Process Registration" button, and mail or bring payment to the triathlon.
Fee: $20 solo; $35 team of 2; $45 team of 3 or 4; $45 for family (mom, dad, kids).
NOTE: T-Shirts are free for ages 12 and under. Otherwise T-shirts are $10 each. T-shirts are guaranteed if ordered before March 22. After that date remaining T-Shirts will be sold on a first-come, first-served basis.
Triathletes are encouraged to bring water or other non-alcoholic, liquid refreshment and snacks as desired.
Nelson Co. Recreation Department
Piney River Mini Triathlon
P.O. Box 442
Lovingston, VA 22949
434-263-7130

Your Information
Name:

Age (as of day of race):

Gender:

Email Address:

Home Address:

City, State, Zip:

Day Phone:

Evening Phone:

Emergency Contact:

Shirt Size:
Shirt Type: Adult Youth

Team Information (if applicable)
Team Name:
Number on Team: (1 - 4)

Note: Each participant must complete a registration form! Additionally, you (your parent or guardian if under 18 years of age) must sign a release form. Normally this will be done on race day. However, for those under 18 whose parent or guardian will not be present on race day the release form must be signed by the parent in advance.

Liability/Assumption of Risk Statement:
- By signing below I acknowledge that participation in the event listed above involves inherent risk of physical injury and possibly death. I assume all such risks by voluntarily electing to participate in this event, hosted by the Nelson County Parks & Recreation Department (NCPRD). NCPRD & Nelson County assume no responsibility for any injury and/or property damage/loss in connection with participation in this event.

- Individuals are reminded that they are responsible for their health and should have medical approval prior to engaging in this event. It is highly recommended that individuals have medical insurance.

- In the event of an injury, the injured party is responsible for any expenses incurred, including but not limited to, ambulance, emergency, and/or medical charges for treatment received.

- Anyone guilty of defacing or damaging property will be held financially responsible.

I hereby release Nelson County Parks & Recreation Department (NCPRD), The County of Nelson, employees, administrators, and volunteers from any and all claims I may have for personal injury or property loss/damage I may incur by participating in this event.

<=Click The Button to Send Your Registration Information

NOTES:
1. If you have trouble with this form simply email the infomation requested above to
crichardson@nelsoncounty.org with a subject of "Piney River Triathlon".

2. Checks should be made payable to Nelson County.

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