Laguna Phuket Triathlon – Kids Splash ‘n’ Dash
Registration

Entry
Now - 25 November 2008
Individual
THB 1,000.-

Entry Fee Includes:

T-shirt
Number belt
Race number
ChampionChip Timing
Water on the run course
Refreshments after the race
Finisher Medal

ONLINE REGISTRATION FORM ( Fields marked with * are required )
Entry Date :
*Category :
Boys 8-10 years of age
Boys 11-12 years of age
Boys 13-14 years of age
Boys 15-17 years of age
Girls 8-10 years of age
Girls 11-12 years of age
Girls 13-14 years of age
Girls 15-17 years of age
* Given Name:
* Family Name:
* Nationality:
*Gender:
*Date Of Birth : - - (dd - mm - yyyy)
*Age : (Age on 6 December 2008)
*T-Shirt Size :
*Address 1 :
Address 2 :
Suburb :
State / Province :
*Postal Code :
*Country of Residence :
*E-mail (First priority) :
*Confirm E-mail (First priority) :
Second E-mail :
*Home Phone :
*Mobile :
Facsimile :
*Guardian Contact Name 1 :
*Guardian Contact Telephone 1 :
Guardian Contact Name 2 :
Guardian Contact Telephone 2 :
Significant Athletic Accomplishment or Interesting Personal Story :
Do you have any current medical problems or conditions for which a doctor is treating you ? Yes
No
Details :
Are you allergic to any medications ? Yes
No
Details
Do you wish the event medical staff to be aware of any specific medical problem ? Yes
No
Details :
Remarks :
I certify that I am medically fit to complete and fully understand that I enter at my own risk, and the organizers will in no way be held responsible for any injury, illness of loss, during or as a result of the event.
Further, I certify that I have been given permission by my legal guardian to participate in the event.
 
 
(Before you register for the race, please read Race Rules)
   
 

(*Registration for events, online registration forms can function properly only on Internet Explorer and Safari*)

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