Registration Contacts Tel0769810577 , Fax 086 694 7780 , E-Mail

Registration Contacts Tel0769810577 , Fax 086 694 7780 , E-Mail

KWAZULU NATAL CANOE UNION

P.O. Box 12135, Dorpspruit, 3206.

Registration contacts Tel0769810577 , Fax 086 694 7780 , e-mail

REGISTRATION FORM 2016-2017

Forms to be completed by the paddler and submitted to their clubs with the necessary fees, who will then pay KNCU and fax the forms with proof of payment to 086694 7780, before 16h00 every Thursday afternoon. Registrations received without proof of payment will not be processed and registrations received after the 16h00 cut-off every Thursday will not be processed until the following week

Please mark with a X or fill in the box as necessary

Have you ever completed a Dusi Canoe Marathon before Yes No

Type of Registration / First Time
Re-Registration
Transfer from another Club =
CSA Number
Initials
First Name
Surname
Home Telephone
Cell Number
Work Telephone
Fax Number
Seconders Cell
E-mail
Date-of-Birth
Sex / Male
Female
Club and School if not the same
Development Paddler
Novice - 1st Year ever registered
Race Group – required by Dept of
Sport and SASCOC reports. / Black
White
Coloured
Indian
Asian
Disability – brief details
Family Membership(3rd family member onwards and Juniors only)
RSA ID Number
Postal Address
Post Code
Registration Date
Medical Aid Name
Medical Aid Number
Medical Aid Main Member Name
T Shirt Size / S
M
L
XL
XXL
XXXL
Employment Position
Occupation
Occupation Description
Marital Status / Married
Single
Disciplines that you take part in / Canoe Polo
Dragon Boat
Marathon(River and/or Flat)
Offshore Ski Racing
Rodeo
Slalom
Sprints
Wave-ski
Wild Water
CSA INDEMNITY: I HAVE READ AND UNDERSTOOD THE INDEMNITY ATTACHED AND DECLARE THAT I AM AWARE OF ITEMS 1. & 2. AND AS SUCH UNDERTAKE TO COMPLY WITH ITEM 3. (a) (b) (c) 4. (a) (b) (c) (d) & 5. AND AS A MINOR’S PARENT HAVE READ AND AGREE TO THE SECTION DEALING WITH MINORS
…………………………………… / ……………………………………
SIGNATURE / SIGNATURE OF MINOR’S PARENT/GUARDIAN
…………………………………… / …………………………………………
SIGNATURE OF CLUB OFFICIAL AS WITNESS / DATE
TEMPORARY LICENCE FEE FOR NON PAID UP MEMBERS IS R50 PER RACE. PROOF OF PAYMENT OF THE FOLLOWING FEES MUST ACCOMPANY THE REGISTRATION FORM

NB: R100 ADMINISTRATION FEE MUST ACCOMPANY TRANSFERS DURING THE SEASON.

50 PENALTY MUST ACCOMPANY ALL LATE REGISTRATIONS RECEIVED BY THE KNCU OFFICE AFTER 30TH SEPTEMBER 2016 (New and Junior members exempt)

KNCU-CSA 2016-2017 Registration Fees
Category / CSA FEE / KNCU FEE / DUCT / TOTAL / DETAILS
Seniors / R320.00 / R300.00 / R70.00 / R690.00 / All Senior
Juniors / R100.00 / R120.00 / Free / R220.00 / Juniors under the age of 18yrs on the 1st January 2016 [born on or after 01.01.1998]
Junior Development / Free / R25.00 / Free / R25.00 / All Juniors under the age of 18yrs on the 1st January 2016 who are from disadvantaged backgrounds.
U23 Development paddlers / Free / R50.00 / Free / R50.00 / All U23 paddlers from disadvantaged backgrounds.
All other senior development paddlers / R320.00 / R300.00 / R70.00 / R690.00 / All Senior development paddlers unless special dispensation to continue at the U23 rates has been received from KNCU . Each case to be evaluated based on proven income.
3rd Family member registering / Free / Free / Free / R0.00 / To be eligible for this discount, the 3rd free family member must be a junior.
Pro-Rata discount Senior / R160.00 / R150.00 / R70.00 / R380.00 / This 50% discount is valid only for U23 and senior paddlers joining their Union and CSA after the 1st October and only people who have never registered with any Union before.
Pro-Rata discount Junior / R50.00 / R60.00 / Free / R110.00 / This 50% discount is valid only for junior paddlers joining their Union or CSA after the 1st October and only people who have never registered with a Union before
University Students / R100.00 / R120.00 / Free / R220.00 / This discount is only valid for Undergraduate students, studying a full time degree and must provide their Union with a copy of their student card with registration form. These students must be under the age of 25yrs on 1st January 2016 [born on or after 01.01.1991]
A R50 penalty must accompany all late registrations received by the KNCU office after the 30 September 2016 [New and Junior members exempt]

NATIONAL, PROVINCIAL AND CLUB INDEMNITY/SAFETY DECLARATION

  1. I am aware of the potential dangers involved to which I will be exposed by participating in canoeing and associated activities;
  1. I am further aware that Canoeing South Africa and it’s affiliated Unions, and all subordinate bodies and officials as well as sponsors of events, in organizing and permitting my participation in such activities and in establishing and enforcing safety measures in regards thereto, cannot ensure my safety and/or the adequacy of such measures.
  1. As such, I undertake to:

(a)participate in all canoeing and associated activities at my own sole risk and responsibility;

(b)exonerate all persons and bodies involved in the organization and sponsorship of canoeing under the auspices of Canoeing South Africa and affiliated Unions from, and indemnify them against, any loss or damage which I or any others, including my dependants, may suffer as a result of any injury or death resulting from any act or omission on the part of such body or person, whether due to negligence (including gross negligence) or otherwise;

(c)comply with all safety and other rules and regulations of Canoeing South Africa and all affiliated Unions and subordinate bodies;

  1. I have received and had an opportunity to review the ICF Anti-Doping Rules.

(a)I consent and agree to comply with and be bound by all of the provisions of the ICF Anti-Doping Rules, including but not limited to, all amendments to the Anti-Doping Rules and all International Standards incorporated in the Anti-Doping Rules

(b)I acknowledge and agree that National Federations and the ICF have jurisdiction to impose sanctions as provided in the ICF Anti-Doping Rules.

(c)I also acknowledge and agree that any dispute arising out of a decision made pursuant to the ICF Anti-Doping Rules, after exhaustion of the process expressly provided for in the ICF Anti-Doping Rules, may be appealed exclusively as provided in Article 13 of the ICF Anti-Doping Rules to an appellate body for final and binding arbitration, which in the case of International-Level Athletes is the Court of Arbitration for Sport.

(d)I acknowledge and agree that the decisions of the arbitral appellate body referenced above shall be final and enforceable, and that I will not bring any claim, arbitration, lawsuit or litigation in any other court or tribunal.

  1. I undertake to wear a buoyancy jacket that conforms to the requirements of Canoeing South Africa and affiliated Unions, if I do not qualify for the exemption.

______

SIGNATURENAME

MINORS (UNDER 21 AND NEVER MARRIED)

I, the parent/guardian of the abovementioned person, permit him/her to participate at his/her own risk and responsibility upon the basis and subject to the provisions set out above.

I consent to the abovementioned person being tested for banned substances, should it be deemed necessary by the relevant qualified authority

______