2015 CANADIAN LIFEGUARD EMERGENCY RESPONSE CHAMPIONSHIPS

Registration Package

May30 et 31, 2015• Gatineau, Québec.

EVENTSFirst Aid • Water Rescue • Priority Assessment

AWARDSAwards will be issued in accordance with the Canadian Competition Manual (2012 edition).

ENTRY DEADLINERegistration and complete entries must be received by May 1, 2015. at 17:00.
No late entries will be accepted. Registration and entries are considered complete when all of the following have been completed in full and received:

  • Registration form
  • Waiver and Release form
  • Event Entry form
  • Copy of each competitor’s current Lifesaving Society National Lifeguardaward
  • Copy of registered athlete card or registered athlete number

ENTRY FEES

Before April 17, 2015 / After April 17, 2015
Team entry fee / $180 / $200
Banquet ticket / $45 / $50

REGISTRATIONSend all registrations documents by mail, fax or e-mail at:

Att. Louis-Philippe GravelPhone: 514 254-3100, ext. 3457

Lifesaving SocietyFax: 514-254-6232
4545 av Pierre-De Coubertin E-mail:
Montréal, QC H1V 0B2

ACCOMMODATIONQuality Inns & Suites

111 rue Bellehumeur, Gatineau, QC J8T 6K5

Phone: 819 568-5252

Name of reservation group: Lifesaving society – individual

Rate: $110 + taxes

COMPETITION SITE

Centre sportif de Gatineau

850 boulevard de la Gappe

Gatineau, QC J8T 7T7

Phone: 819 503-8500

2015 CANADIAN LIFEGUARD EMERGENCY RESPONSE CHAMPIONSHIPS
EVENTS

For the following events shall be conducted without male and female categories:

SERC Events / Total Number of Persons per Team
First Aid / 4 competitors per team
Water Rescue / 4 competitors per team
Priority Assessment / 4 competitors per team
SCHEDULE OF EVENTS

Friday,May 29 2015Centre sportif de Gatineau

18:00 to 20:00Key Officials Meeting

18:00 to 20:00Club Check-in & Facility Tour

20:00 to 21:00Coaches Meeting

Saturday,May 30 2015Centre sportif de Gatineau

07:15Officials and volunteers meeting

08:15First Aid Lock-up

08:30First Aid Prelims

12:00Opening Ceremonies

13:15Water Rescue Lock-up

13:30Water Rescue Prelims

17:30Priority Assessment Lock-up

17:45Priority Assessment Prelims

Sunday,May 31 2015Centre sportif de Gatineau

07:15Officials and volunteers meeting

08:15Priority Assessment Lock-up

08:30Priority Assessment Final

10:15First Aid Lock-up

10:30First Aid Final

13:30Water Rescue Lock-up

13:45Water Rescue Final

18:30Banquet & Awards

Schedule is subject to change. Final version of the schedule will be disclosed at the coaches meeting.
2015 CANADIAN LIFEGUARD EMERGENCY RESPONSE CHAMPIONSHIPS

REGISTRATION / FACTURATION
Contact information/Coordonnées pour rejoindre l’équipe
 Club or Affiliate/Nom du Club Affilié
Name/ Nom /  Unattached/ Non affilié
Name/ Nom
Coach/Entraîneur or/ou Manager/Gérant / Mailing Address/Adresse postale
Phone/Téléphone / Fax/Télécopieur
Email/Courriel
/ City/Ville / Province / Postal Code/Code postal
Entries will be confirmed by e-mail/Votre inscription vous sera confirmée par courriel. Please print clearly / Écrivez lisiblement s.v.p.
Registration Fees/Frais d’inscription Coût à l’unité / Price each
How many? Combien? / Description / Avant / Before
17/04/15 / Après / After
17/04/15 / Line total/
Total de cette ligne
Event Entry fee (per team, does not include banquet ticket)
L'entrée d'événement (par équipe,billet de banquet non inclue) / $180.00 / $200.00
1 Banquet Ticket
1 Billet pour le banquet / $45.00 / $50.00
Total
Payment/Paiement
Payment method/
Mode de paiement /  Cheque/Chèque  Money Order/Mandat  VISA  MasterCard
Credit card number/
Numéro de la carte de crédit / Expiry date/date d’expiration
Credit card holder/Nom du titulaire de la carte de crédit
Signature of credit card holder/
Signature du titulaire de la carte
Phone/Email (if different than above)/Téléphone/courriel (s’il est différent de celui ci-dessus)
2015 CANADIAN LIFEGUARD EMERGENCY RESPONSE CHAMPIONSHIPS
Event Entry Form / Formulaire d’inscription pour les épreuves

PLEASE PRINT CLEARLY. ÉCRIVEZ LISIBLEMENT S.V.P.

Team entry form ______of ______form(s). /  Team Name/Nom del’équipe
Coach/Entraîneur or/ou Manager/Gérant / Email/Courriel / Phone/Téléphone
.
Competitor Name/ Nom de l’athlète
Gender/Sexe / Birthdate/
Date de naissance / Indicate team number / indiquez le nombre d’équipes (1 or/ou 2 or/ou 3, etc.)
First Aid/
Premiers soins / Water Rescue/
Surveillance / Priority/
Priorité
Brown, John / MF / 83
05
20 / 1 / 2 / 1
Last name, First name
Nom de famille, prénom / MF / YY
MM
DD
Last name, First name
Nom de famille, prénom / M
F / YY
MM
DD
Last name, First name
Nom de famille, prénom / M
F / YY
MM
DD
Last name, First name
Nom de famille, prénom / M
F / YY
MM
DD
Last name, First name
Nom de famille, prénom / M
F / YY
MM
DD
Team entry form ______of ______form(s). /  Team Name/Nom del’équipe
Coach/Entraîneur or/ou Manager/Gérant / Email/Courriel / Phone/Téléphone
.
Competitor Name/ Nom de l’athlète
Gender/Sexe / Birthdate/
Date de naissance / Indicate team number / indiquez le nombre d’équipes (1 or/ou 2 or/ou 3, etc.)
First Aid/
Premiers soins / Water Rescue/
Surveillance / Priority/
Priorité
Brown, John / MF / 83
05
20 / 1 / 2 / 1
Last name, First name
Nom de famille, prénom / MF / YY
MM
DD
Last name, First name
Nom de famille, prénom / M
F / YY
MM
DD
Last name, First name
Nom de famille, prénom / M
F / YY
MM
DD
Last name, First name
Nom de famille, prénom / M
F / YY
MM
DD
Last name, First name
Nom de famille, prénom / M
F / YY
MM
DD
2015 CANADIAN LIFEGUARD EMERGENCY RESPONSE CHAMPIONSHIPS
WAIVER AND RELEASE

Please read carefully before signing

Each competitor must sign this form with the entry form to be eligible to compete. Participants 18 years and under must have the form signed by their parent or guardian.

  1. Conduct

I agree to abide by the rules, regulations, and code of conduct of the championship, and further to behave in a manner consistent with good sportsmanship.

  1. Voluntary Assumption of Risk

As a competitor in a lifeguard competition, I recognize that there are certain risks inherent in the activity as a result of factors including but not limited to, stress, number of people, water temperature and conditions. I have prepared myself for the competition and know of no factor or condition which should be disclosed to the organizers or which would make it unsafe for me to compete. I voluntarily assume all risks, both physical and legal including but not restricted to loss or damage to property, and personal injury including permanent disability or death.

  1. Waiver of Liability

As a condition of entry and in consideration of my application as an individual or as part of a team being accepted, I hereby waive my right to make any claim, whether for negligence or otherwise against the Lifesaving Society, city of Gatineau, the owner or occupier, the sponsors, the organizing committee or any of the servants, agents, affiliates, volunteers, judges, officials, or other persons involved in the organization of and the running of the competition, events or sanctioned associated activities. I further agree to indemnify and hold harmless all of the above, from any claim made on my behalf or as a result of injury to my person or property.

  1. Model Release

I transfer to the Lifesaving Society all rights whatsoever which I have in photographs and/or videos that photographers may have taken. I consent to the use of the photographs/videos and my name for all purposes whatsoever, including without limitation, television, publications, and any trade or advertising purposes.

I have carefully read and understand the four conditions of entry and in consideration for being allowed to compete, I have executed them voluntarily intending to be bound thereby and intending these conditions to be binding of my heirs, personal representative and assigns.

Print Name / Signature / Date
Coach
Manager
Captain
#2
#3
#4
#5
#6
#7
#8

Copy this form for additional competitors.