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The Cody Parks & Recreation Department does not provide medical insurance to cover participants during an activity. This is the respon- sibility of each individual involved in any department program or activity. I hereby give my consent for myself and/or for to participate in recreational activities sponsored by the Cody Parks and Recreation Department in Cody, Wyoming, during any session of the recreation program. I hereby release the Sho- shone Recreation District, Recreation Director, recreation Staff and Board of Directors, the Cody Parks and Recreation Department, the City of Cody, all City staff, volunteers and Sponsors associated therewith from all liability, including claims and suits at law or in equity for any injury fatal or otherwise, while participating in any of the recreation activities and understand that I will be fully responsible for any damage or injuries incurred by the participant while involved in any Recreation Department activity. Signature date * Parental guardian if under 18 12th annual summer tri Saturday, September 10, 2016 Beck Lake Park 2401 14th Street Cody, WY 82414 Event includes: a 500 yard open water swim @ new Cody reser- voir; a 6 mile bike ride on the new beck lake trails or a +/-14 mile road ride on hwy 14 16 20, and a 3 mile run. Male female Age on race day: Address: Email: Circle One: Individual Team team members: (each member must sign waiver) Swimmer: (July water temperature was 70 degrees; wet suits are allowed, but not required.) Cyclist: Runner: While the off-road bike race is encouraged, racers may elect to ride an approximate 14 mile road ride on HWY 14 16 20 to Cody Archery Range INSTEAD. Please indicate your bike leg: Beck Lake Mountain Bike Trails Road ride HWY 14 16 20 PLEASE TAKE OR MAIL ALL ENTRIES TO THE PAUL STOCK AQUATIC & RECREATION CENTER: 1402 HEART MOUNTAIN STREET /P.O. BOX 2200 CODY, WY 82414 Checks can be made payable to the City of Cody. Cost on or before August 29: $35/individual or $70/team. After August 29, a $15 late fee applies. Race starts @ 7 a.m. 2 minute staggered starts by age group & gender Race info packets available September 1 CODE: 260003-1