Event Waiver And Authority Form printable pdf download

SPORT WAIKATO - REGIONAL SECONDARY SCHOOLS WAKA AMA

EVENT WAIVER and AUTHORITY FORM

I declare that:

1. My accepted entry will not be transferred to another entrant.

2. In the event of any “act of God” conditions causing a cancellation of the event, my total

entry fee is not transferable or refundable.

3. I acknowledge that there are risks involved with Waka Ama

and fully realise the dangers of participating in an event such as this and fully assume the

risks associated with such participation and my wellbeing during the event.

4. I understand and agree that situations may arise during the event, which may be beyond the

immediate control of ofﬁcials or organisers, and I must continually participate in a manner that does

not endanger either me or others.

5. Neither the organisers, the sponsors nor other parties associated with the event shall have any

responsibility, ﬁnancial or otherwise, for any risk incident that might arise, whether or not by

negligence, from any direct or indirect loss, injury or death that might be sustained by me or any

other party directly or indirectly associated with me, from my intended or actual participation in the

event or its related activities.

6. I authorise my name, voice, picture and information on this entry form to be used without payment

to me in any broadcast, telecast, promotion, advertising, or any other way pursuant to the Privacy Act

1993.

7. I agree to comply with the rules, regulations and event instructions of the Regional Secondary school

marathon Champs.

8. I consent to receiving medical treatment which may be advisable in the event of illness or injuries

suffered during the event.

the race

I confirm that I can swim 50 Metres/OR if I cannot swim 50 Metres I will wear a PFD during

Full Name or competitor

School:_________

____________

Signed _______________________________________________ Date _____________________

Date of birth

If Competitor is under 18 the Waiver must be signed by Parent or guardian:

Full name of Parent/guardian

School: _______________

Signed _______________________________________________ Date _____________________

Team Name_____________________________________________________________________

Any Medical Condition we should know of? ___________________________________________

Event Waiver And Authority Form