THE BREEZE 2019 PADDLE FOR LIFE
ENTRY FORM & WAIVER
Saturday 16th February 2019 – Caroline Bay, Timaru
Postponement Date: Sunday 17th February 2019
10am – 3pm
Paddleboards are provided but you can bring your own to use for the event

ENTRIES to be received by Monday 11th February 2019

Name of Team
(Teams of 2 -4) Note: there will be 4 laps of the course regardless of the number of team members
Your answer
Please select a team category
Own Paddle Board?
How did you hear about Paddle for Life?
Team Captain’s Name
Your answer
Address:
Your answer
DOB:
Your answer
Email:
Your answer
Ph:
Your answer
Emergency Contact & Ph:
Your answer
Team Member 2:
Your answer
DOB:
Your answer
Email:
Your answer
Emergency Contact & Ph:
Your answer
Team Member 3:
Your answer
DOB:
Your answer
Email:
Your answer
Emergency Contact & Ph:
Your answer
Team Member 4:
Your answer
DOB:
Your answer
Email:
Your answer
Emergency Contact & Ph:
Your answer
Event Disclaimer
FOR YOUR INFORMATION: You will be asked to sign an event disclaimer on the day of the event.

I have read and understand the information regarding this event and understand that I participate in this event at my own risk.

I understand that the event organisers will take and have taken all practicable steps to isolate, minimize, and eliminate the hazards associated with this event. I understand that on the day of the event all risks will be disclosed to participants prior to the event starting

I hereby attest and verify that I am physically fit, water confident and have sufficiently trained for this event. Any pre-existing medical conditions that may affect my involvement in the event have been disclosed to the event organisers.

I agree to comply with the rules and directions of event officials and their personnel.

I hereby allow the use of my name and image to be used in the media and for marketing purposes.

I hereby agree that in the case of event cancellation due to extreme inclement weather (at the discretion of event officials), my entry fee shall be non-refundable.

I hereby acknowledge this waiver, release and indemnity discharge all persons, corporations, associations and bodies involved or otherwise engaged in promoting or staging the event and their servants, agents, representatives, officers and employees. This includes but is not limited to the various committees, members, and employees of all independent contracted suppliers to the event, local councils, cities and districts and their respective officers, directors, employees, independent contractors, representatives, agents, volunteers, event organisers and sponsors whether or not the loss, injury or damage is attributed to the act or neglect of any or more of them.

I hereby acknowledge that if I use any personal equipment during the event, that I am solely responsible for ensuring the equipment is used/worn to the manufacturer’s recommendations and complies with all Maritime NZ rules and Timaru District Council By-laws. I agree that should any damage occur to any personal equipment used it is solely my responsibility.

Event refund policy: There will be no refunds made for this event. ALL PROCEEDS GO TO THE PINC AND STEEL CANCER REHABILITATION TRUST FOR USE IN THE SOUTH CANTERBURY REGION.

I agree to the terms & conditions *
Required
Payment Information
PINC & STEEL CANCER REHABILITATION TRUST BANK ACCOUNT: 02-0888-0089529-000

Please add team captain surname as reference when paying by online banking, or cheques payable to the above account.

ENTRIES by Monday 11th February 2019 please
Race prizes and spot prizes on the day
Submit
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