733 HIGH St, KEW EAST, VICTORIA, 3102

Ph 03 9857 0110, Fx 03 9857 0158

ACN 006 311 842ABN 93 032 992 179

T.ID. APPLICATION FORM 2009

Please tick the appropriate box

TID CAMP,Nov 21-23. Meals, camp fees, coaching, slalom entries, $235

TID for parents, Nov 21-23. Meals, camp fees, coaching, etc $235

I have a parent who will help with food preparation(no charge)

Charge per additional family members staying on site (included meals) $20

PLEASE FILL IN MEDICAL FORM, ATTACHED

Closing date for Applications:Friday Oct 23rd

A Late entry fee of $50 will apply to all late entries!!

Payment details - PTO

Please make cheques payable to: A.F.K. Pty Ltd

Or pay by Direct bank deposit, writing the paddlers name in the “description”

BSB – 033054

A/C - 244802

Refund Policy:

A full refund will be given up to the application closing date

No refunds will be given for cancellation after the closing date without a medical certificate.

For cancellation later than 7 days before the commencement of the course NO REFUND can be given, even with a medical certificate

Program

The TID, or Talent Identification, camp will be held on the Goulburn river, near the town of Eildon, about 2 hours drive from Melbourne. The camp will start at 9:00am on Friday morning & conclude on Sunday, after the race (about 3:00pm). Athletes will get 2 coaching sessions on both Friday & Saturday and receive race coaching on Sunday. Main meals will be provided from Friday Dinner to Sunday Breakfast. Camping fee’s are included (at OEG) but you are required to BYO tent & sleeping bag.

All athletes must be self sufficient. We will provide you with coaching & main meals, but you need to provide your own kayaking equipment, camping gear & transport. Every athlete needs to have a Guardian and be a member of a canoe club. We recommend Canoes Plus Racing Team, junior membership is $75 for 1 year and includes generous discounts from Canoes Plus, Canoe Victoria Insurance coverage and a subscription to Water Magazine.

Coaching

The TID camp usually provides Australia’s best junior development coaches (which are often the best senior coaches as well). There are usually some Olympians, National Senior & Junior Team coaches working on the course.

Late entry fees

We urge all participants to apply in plenty of time. A late entry fee of $50 will be charged for any late applications, if room permits.

Payment

Please make all cheques payable to Andrew Farrance Kayaking Pty Ltd, and send to Canoes Plus, or pay by Direct Bank Deposit

BSB – 033054

A/C - 244802

If you have any queries relating to the camp please do not hesitate to call Tel: 03 9857 0110,

Fax: 03 9857 0158

MEDICAL INDEMNITY FORM

Please answer the following questions honestly, giving full details where required. This document is strictly confidential.

Participant Information

Surname……………………………………… First Name…………………………………… Other Initials……………..

Address…………………………………………………………………………………………………………………………………………………..……….

Tel # 1………………………………..……….…Tel # 2……………………………………... DOB .…/.…/….

Emergency Contact Details

Relationship to Participant………………………………………………………………………………………………………………………………

Surname……………………………………… First Name…………………………………… Other Initials………………

Address…………………………………………………………………………………………………………………………………………………………….

Tel # 1 ………………………………………………………. Tel # 2 ……………………………………………………….

Medical & Participant Information
  • Do you suffer from Asthma?Yes/No
  • Do you have known allergies?Yes/No
  • Are you allergic to Penicillin?Yes/No
  • Do you suffer from any heart conditions?Yes/No
  • Do you have any known medical condition?Yes/No
  • Do you suffer from any pre-existing injury?Yes/No
  • Are you currently taking any medication?Yes/No

If you have answered yes to any of these questions please provide details of the nature of your condition(s) and or medication.

……………………………………………………………………………………………………………………...………………………………………………..……

…………………………………………………………………………………………………………………………………………………………………….……...

………………………………………………………………………………………………………………………………………………………………………………..

  • Can you swim 50 metres?Yes/No
  • What was the date of your last tetanus Injection?.…/.…/….

Is there any other information you feel maybe relevant to us in the case if an emergency?

………………………………………………………………………………………………………………………………………………………………………………

PLEASE TURN OVER

CKEA forthe purposes of this declaration means and includes Canoe Kayak Education Australia, AFK & and Canoes Plus Pty Ltd, it’s staff and their respective directors, officers, servants or agents.

Fitness to participate

I declare that I am medically and physically fit and able to participate in this course. I am not and must not be a danger to myself or the health and safety of others and will notify CKEA immediately of any change in my fitness.

Warning and Declaration

Participation in canoeing can be inherently dangerous. Risks may include but are not limited to, overexertion, weather incidents, water quality, equipment failure and serious accidents which may result in my death, personal injury or my property being damaged. I have voluntarily read and understood this warning and accept and assume the inherent risks in the course.

Exclusion of Liability

Except where provided or required by law and as such cannot be excluded, I agree that it is a condition of taking part in this course that CKEA is absolved from all liability however arising from injury or damage however caused (whether fatal or otherwise) arising out of my participation in the course.

Release and Indemnity: In consideration of CKEA accepting my application for this course I:

a)release and forever discharge CKEA from all claims that I may have had but for this release arising from or in connection with my participation in this course, and

b)indemnify and hold harmless CKEA to the extent permitted by law in respect of any claim by any person including but not only another participant in the course arising as a result of or in connection with my participation in the course.

WARNING UNDER THE FAIR TRADING ACT 1999
Under the provisions of the Fair Trading Act 1999 several conditions are implied into contracts for the supply of certain goods and services. These conditions mean that the supplier named on this form is required to ensure that the recreational services it supplies to you are
  • Rendered with due care and skill, and
  • As fit for the purpose for which they are commonly bought as it is reasonable to expect in the circumstances, and
  • Reasonably fit for any particular purpose or might reasonably be expected to achieve any result you have made known to the supplier.
Under section 32N of the Fair Trading Act 1999, the supplier is entitled to ask you to agree that these conditions do not apply to you. If you sign this form, you will be agreeing that your rights to sue the supplier under the Fair Trading Act 1999 if you are killed or injured because the services were not rendered with due care and skill or they were not reasonably fit for their purpose, are excluded, restricted or modified in the way set out in this form.
NOTE: The change to your rights, as set out in this form, does not apply if you death or injury is due to gross negligence on the supplier’s part. “Gross negligence” is defined in the Fair Trading (Recreational Services) Regulations 2004.

I acknowledge that canoeing is considered a high-risk activity and accept those risks. I hereby declare that the information I have given is both complete and correct. I also understand that CKEA staff will access this information or pass it onto emergency services personnel where appropriate.

I agree that if I suffer injury or illness CKEA can at my cost arrange medical treatment and emergency evacuation as CKEA deem essential for my safety.

Signature………………………………………………………………………………… Date………………….

Where participant is under 18 years of age

Guardians Signature.……………………………………………………………………. Date…………………