2023 Futureproof Life Rodney Coast Challenge Team Entry Form

Given Name *

Of team leader

Family Name *

Of team leader

Team Name *

Please use business name if entering Corporate Team Challenge - e.g. : "Dave's Cafe Team 1"

Phone *

Postal Address *

Post Code

Entry Fees - includes event t-shirt*

Team of 2 $ 199 (Youth 13-18 $ 170)
Team of 3 $ 245 (Youth 13-18 $ 199)
Team of 4 $ 290 (Youth 13-18 $240 - Use your own kayak)
School Team of 4 - Schools Challenge $299 (Kayak Supplied - Same Kayak for every team)

Youth competitors in any category can hire a kayak for $99 delivered - this is an entry level racing ski (sit on top)

- Please note kayak hire is included in the "Schools Team of 4 Challenge".

*Event t-shirts are included in race packs for entries received before 6th November 2023

Entries received after 12th November 2023 will be deemed to be late entries. Late entry fee $30.00

No refunds after 12th November 2023 without medical certificate

Entry Category *

Run Stage Given Name *

Run Stage Family Name *

Run Stage Email *

Please enter the actual competitors email address, not just the team leaders

Road Cycle Stage Given Name *

Road Cycle Stage Family Name *

Road Cycle Stage Email *

Please enter the actual competitors email address, not just the team leaders

Mountain Bike Stage Given Name *

Mountain Bike Stage Family Name *

Mountain Bike Stage Email *

Please enter the actual competitors email address, not just the team leaders

Kayak Stage Given Name *

Kayak Stage Family Name *

Kayak Stage Email *

Please enter the actual competitors email address, not just the team leaders

Event T-shirts

Event t-shirts are included in race packs for entries received before 6th November 2023. Please indicate sizes required below:

0

1

2

3

4

XS

S

M

L

XL

XXL

Ladies 8

Ladies 10

Ladies 12

Ladies 14

Ladies 16

Ladies 18

Clear selection

Entry Fees - includes event t-shirt

Team of 2 $ 199 (Youth 13-18 $ 170)
Team of 3 $ 245 (Youth 13-18 $ 199)
Team of 4 $ 290 (Youth 13-18 $240 - Use your own kayak)
School Team of 4 - Schools Challenge $299 (Kayak Supplied - Same Kayak for every team)

Youth competitors in any category can hire a kayak for $99 delivered - this is an entry level racing ski (sit on top)

- Please note kayak hire is included in the "Schools Team of 4 Challenge".

*Event t-shirts are included in race packs for entries received before 6th November 2023

Entries received after 12th November 2023 will be deemed to be late entries. Late entry fee $30.00

No refunds after 12th November 2023 without medical certificate

Total Entry fee *

Donation

Any donations to the Kaukapakapa Scout Group are gratefully received, they make this event possible

Payment details

Please pay by direct credit to: 12-3139-0048950-01. Please enter team or family name as reference

Entries with a postal date after 12th November 2023 will be deemed to be late entries. Late entry fee $30.00

No refunds after 12th November 2023 without medical certificate

Total Paid *

Please add up entry fees, donation amount, and late fee if required

Payment Reference *

Please pay with your online bank or by bank deposit, and enter the payment reference you used here. e.g. your team name. If paying for multiple teams please feel free to email payment details to info@rcc.org.nz

Cancellation Refund Policy *

We can run this event at current Covid-19 level 1 or 2. If the Covid-19 level restrictions require event cancellation we offer these options. We will contact you for further details if this should happen

Medical

Do you have any allergies that require you to carry medication during the event e.g. an Epi-pen?

Waiver

To the best of my knowledge I/We are physically capable of competing in this event. On behalf of myself and/or fellow team members, I/We accept full responsibility and /or liability for any damage to myself, equipment, fellow team members and/or third parties resultant from my/our participating in the Rodney Coast Challenge event and I/We waiver all or any claims against the race organisers and/or their staff. I/We also acknowledge I/We understand that at no stage are any roads closed to the General Public and I/We must at all times obey road rules in relation to cyclists or pedestrians. I/We also acknowledge that a charge of $30 will be made for any unreturned or lost race bibs and/or transponders

Signed *

Your full name here