Request appointment at
Emergency Medical Services
Inpatient Acute Care
Billing & Financial
Patients & Visitors
Main Campus Map
Events & Education
Triathlon Individual Entry
Individual Entry - Swim, Bike, Run
State / Province / Region
ZIP / Postal Code
Date Format: MM slash DD slash YYYY
Emergency Contact Name
Any other comments or information?
I agree to the Idemnity and Media release.
Idemnity Release: “I/we acknowledge that by signing this document, I/we know that participating in this Triathlon (swim/bike/run) is potentially hazardous and has an inherent risk with the possibility of permanent injuries and death. I/we also acknowledge and assume any and all risk associated with this event including but not limited to falls, contact with other participants, the effects of the weather, including high heat and/or humidity, effects of the water, and the condition of the roads and traffic and any and all other risk association with this triathlon and I do voluntarily agree to waive any and all such risk and have taken whatever action I/we deem appropriate to ascertain the nature of any such risk association with this triathlon. I/we acknowledge that I/we am/are medically able and properly trained to participate in said triathlon. I/we further agree to indemnify and hold harmless North Lincoln County Hospital District d/b/a Star Valley Medical Center, its agents, volunteers, employees, affiliates, insures, and any other party collectively the (“Released Party”) from all losses, liabilities, damages and demands which result from or during my participation in said triathlon and I/we agree and covenant not to sue or make any claim against the released parties for and from any and all actions, causes of actions, claims, demands, damages, injury, losses, costs, expenses, compensation, rights, debts, liabilities, obligations, payments of every kind and character, known or unknown, existing or contingent, regarding or arising from, on account of or in any way related to my participation in said triathlon. I further acknowledge that Wyoming law governs this Release Agreement and should any claim or lawsuit arising out of said agreement involve the released parties, it shall only be brought in the State Courts in Lincoln County, Wyoming.”
Media Release: “I/we give Star Valley Medical Center and their associates (ex: SVI Media) the irrevocable right to use my/our name, picture, photograph, portrait, visual likeness, or voice in all forms and media in all manners, including photo, film, audio and video representations, for non-profit, public purposes, and I/we hereby waive any right to inspect or approve the finished product that may be created in connection therewith. I/we have read this release, and am/are fully familiar with its contents.”
Applications for minors are not accepted for this event.