REGIONAL TRIATHLON CENTRE GENERAL INFORMATION

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1 GENERAL INFORMATION Date Name Vancouver Address Street City Postal Code Phone number Mobile number e.mail Twitter Other social media DD/MM/YY Province Skype Home Address (if different from above) Street City Province Postal Code Country Phone number Age Birthdate DD/MM/YYYY Occupation Student School Provincial Triathlon Association Membership Number TriBC ATA STAC OAT Are you applying as a foreign athlete? YES NO Triathlon Canada Regional Triathlon Centre Vancouver

2 ENTRANCE PERFORMANCE STANDARDS " Include proof of performance referenced as per Triathlon Canada policy SWIM PERFORMANCE DISTANCE TIME DATE REFERENCE 400 h:mm:ss dd/mm/yy 800 h:mm:ss dd/mm/yy 1500 h:mm:ss dd/mm/yy RUN PERFORMANCE DISTANCE TIME DATE REFERENCE 1500 h:mm:ss dd/mm/yy 3000 h:mm:ss dd/mm/yy 5000 h:mm:ss dd/mm/yy 1000 h:mm:ss dd/mm/yy TRIATHLON, SWIM or RUN PERFORMANCES OF NOTE OTHER SPORTS PLAYED Athlete Signature If athlete is under 19, parent or guardian must also sign below Parent Signature Triathlon Canada Regional Triathlon Centre Vancouver

3 Triathlon Canada Regional Triathlon Centre Athlete Agreement # In consideration of your acceptance to the Triathlon Canada Regional Triathlon Centre (RTC) in Vancouver you agree: 1) To not violate any principles outlined by the Canadian Centre for Ethics in Sport including the taking of banned substances or associating with participants engaged in such practices. 2) To abide by the disciplinary and appeals procedure of Triathlon Canada with general application to conduct and discipline while in the RTC program. 3) To conduct yourself in a professional and sportsmanlike manner at all times while in the RTC program. 4) To provide Triathlon Canada with; any current medical conditions, a medical history of treatment, complete a medical screening upon intake to the RTC, and arrive at the RTC with a sufficient level of base fitness necessary to train at a high level of intensity. 5) Consent to receive medical treatment deemed advisable in the event of injury, accident or illness while participating in the RTC program. 6) To complete an athlete/coaching agreement upon arrival at the RTC that outlines the expectations of the athletes and the coaches. 7) Agree to allow your photo and likeness for use by Triathlon Canada in promotional and educational purposes. Triathlon Canada Regional Triathlon Centre Vancouver

4 8) For my executors, administrators, heirs, next of kin, successors and assigns, I waive and release any and all claims that I may have against Triathlon Canada, its employees, officials, directors, members, volunteers and agents, Canadian Sport Centre Pacific and their executors, administrators, heirs and assigns, for all injuries or death suffered by me while participating in the Regional Triathlon Centre. Furthermore, I understand that failure to abide by the above conditions may result in disciplinary actions by Triathlon Canada as provided by the Disciplinary and Appeals procedures. $ DATE DD/MM/YY Athlete Signature If athlete is under 19, parent or guardian must also sign Parent Signature Triathlon Canada Regional Triathlon Centre Vancouver

5 PERSONAL COACHING HISTORY % Details of coaching history (duration, past coaches, clubs, etc.) Do you currently have a personal coach YES NO Coach name Personal coach contact information Phone e.mail Additional coaching details Triathlon Canada Regional Triathlon Centre Vancouver

6 MEDICAL and EMERGENCY CONTACT INFORMATION & Do you have medical health care coverage in BC? BC Medical Services Plan (MSP) # Details of other coverage Emergency Contact Information *Please include all country codes and regional dialing information Primary Contact Name Relationship City and Country Home phone number* Mobile number* Alternate Contact Name Relationship City and Country Home phone number* Mobile number* Triathlon Canada Regional Triathlon Centre Vancouver

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