Entry form /
School entry formForm 1 of 3
SCHOOL DETAILS (only required for competitors representing their school)
School name:______
School contact:______
Phone: ______(BH)______(AH)
Fax: ______Email______
Postal address:______
PAYMENT DETAILS
Number of single class entries @ $12.50 per class______Subtotal $______
Number of full championship entries @ $30 per competitor
(limit of 2 slalom classes & 1 downriver class)______Subtotal $______
Number of non-members of Australian Canoeing/
Canoeing Victoria @ additional $5 for whole event______Subtotal $______
(Entry is GST exempt) TOTAL $______
Payment by Try booking
Signature:______
Please find attached a cheque. (Cheques payable to “Victorian Slalom Committee”)
SCHOOL DECLARATION (only required for competitors representing their school)
The teacher in charge at the carnival willbe:______
I understand and agree to the attached Information/conditions of entry for the above-mentioned school in theVictorian Schools Whitewater Championships 2017.
Name:______
Signature:______
Position:______
Mail/Email Entry FormsLyne Strmecki VSTC
or
6 Limassol Court Donvale 3111
Full paymentto:Trybooking / ENTRY CHECKLIST
Forms Attached & Completed:
Form 1 of 3 School Entry Form
Form 2 of 3 Competitor Entry Form
Form 3 of 3 Competitor Declaration Form
Large schools must complete entries on Excel Format Entry. Please Contact Lyne Strmecki for information.
Competitor entry formForm 2 of 3
Name:______
School: (if required) ______
Phone:______Email::______
Date of Birth :______Age Group:______
Canoe Club(if applicable):______
Australian CanoeingRegistration No.(if applicable):______
Age group is calculated by your age on Thursday 31st August, 2017.
Partners/Other Team Members must complete separate entry form as well.
Kayak teams, girls and boys C2 classes must consist of students from the same school. Only single sex schools may combine tocreate a mixed C2 entry with one other school.
Paddlers may enter in two slalom classes and one down river class
The correct type of boat must be used in each class. Please insert X in the correct division and age group
Downriver
10 / 11 / 12 / 13 / 14 / 15 / 16 / 17 / 18+Boys K1
Girls K1
Boys C2
Girls C2
Mixed C2
Boys C1
Girls C1
Slalom
10 / 11 / 12 / 13 / 14 / 15 / 16 / 17 / 18+Boys K1
Girls K1
Boys C2
Girls C2
Mixed C2
Boys C1
Girls C1
Boys team
Girls team
Canoe Partner: ______School:______
Other Slalom Team Members: ______
(Limit 1 junior/senior male/female teams per school) (Name2) (Name 3)
Competitor declaration form (if not a member of Australian Canoeing/Canoeing Vic)Form 3of 3
1. Current members of Australian Canoeing/Canoeing Victoria do not need to complete this form provided their registrationnumber is recorded on Form 2.
2. For juniors U18 this form should be completed and signed by parent or guardian prior to the event.
I______(Name)
Of
______(Suburb/Town)
______(Postcode)
Date of Birth ______Male Female
Email address______
Contact Number______
School name ______
Hereby apply for entry to the Canoeing Victoria activity Event Name: 2017Victorian Schools and Junior Whitewater Championships on 2 and 3 September 2017, at Jumping Creek and Warrandyte.
I acknowledge that Australian Canoeing (AC) and Canoeing Victoria (CV) may use my personal information in accordance with theAustralian Canoeing Privacy By-law.
I have read, understood, acknowledge and agree to the declaration overleaf including the warning, exclusion of liability, release andindemnity AND understand that any photographs or images taken of me are the property of The Club, Canoeing Victoria and Australian Canoeing and can be usedby them or passed onto funding and/or partner organisations without further consent.
I acknowledge that if my application to the Event/Activity issuccessful I will be entitled to participate in the2017Victorian Schools and Junior Whitewater Championships.
Signature:______
Date : ______
Each Non Member Participant must complete this form - Australian Canoeing / Canoeing Victoria - Event License / Activity
Application and Declaration.
For competitors under 18 years of age (U18) this form should be completed and signed by parent or guardian prior to the event
In so applying and in consideration of my application for participation into the Event / Activity being accepted I acknowledge andagree that:
1. “AC” for the purposes of this application and declaration means and includes Australian Canoeing Incorporated, its members(including State Associations and Affiliated Clubs) and their respective directors, officers, members, servants or agents.
2. If accepted I will be permitted to participate in the Event subject to my complying with the terms and conditions of the Event, thisdeclaration and any reasonable direction issued by the Event organisers or their representatives.
3. This document cannot be amended. If I do amend it my application will be null and void. It cannot be accepted by AC.
4. Insurance is in place that provides limited cover to me whilst I am participating in the Event / Activity.
(For insurance details: Got to Membership / Insurance)
I understand that this insurance may not cover me for all injury, loss or damage sustained by me and I can, in my own interests, seekand obtainpersonal insurances over and above the cover provided by AC.
5. The Activity rules and this declaration comprise a contract between me and AC. It is necessary and reasonable for promoting andconducting the Event/Activity.
6. Warning: Participation in the Event/Activity can be inherently dangerous. Risks including but not only (ie. overexertion,equipment failure, dehydration, serious accidents, and weather conditions) can and often do happen which may result in me beingpersonally injured or my property being damaged. I have voluntarily read and understood this warning and accept and assume theinherent risks in the Event/Activity.
7. Exclusion of Liability: Except where provided or required by law and such cannot be excluded, I agree that it is a condition of myentry to the Event (if accepted) that AC is absolved from all liability however arising from injury or damage however caused (whetherfatal or otherwise) arising out of my participation in the Event/ Activity.
8. Release and Indemnity: In consideration of AC accepting my application for participation into the Event / Activity I:
(a) release and forever discharge AC from all Claims that I may have or may have had but for this release arising from or inconnection with my participation in the Event/Activity; and
(b) indemnify and hold harmless AC to the extent permitted by law in respect of any Claim by any person including but not onlyanother participant in the Event/Activity arising as a result of or in connection with my participation in the Event/Activity.
In this clause 8 “Claims” means and includes any action, suit, proceeding, claim, demand, damage, penalty, cost or expense howeverarisingbut does not include a claim in respect of any action, suit, etc. made by any person entitled to make a claim under a relevantEvent/Activity insurance policy.
9. Fitness to Participate: I declare that I am and must continue to be medically and physically fit and able to participate in theEvent/Activity. I am not and must not be a danger to myself or to the health and safety of others. I will immediately notify AC inwriting of any change to my fitness and ability to participate. I understand and accept that AC will continue to rely upon thisdeclaration as evidence of my fitness and ability to participate.
10. Privacy: I understand that the information I have provided is necessary for the conduct of the Event and for the Objects of AC. Iacknowledge and agree that the information will only be used by AC to facilitate the conduct of the Event/Activity and otherevents/Activities conducted by AC. I understand that I will be able to access my information through AC. If the information is notprovided my application may be rejected.
I acknowledge that AC may also use my personal information in accordance with the AC Privacy By-law. I may advise AC if I do notwish to receive from AC any AC sponsors or third parties’ promotional material.
11. Copyright and right to use image: I acknowledge and consent to photographs being taken of me during my participation in theEvent/Activity. I acknowledge that the photographs are owned by AC and that AC may use the photographs for promotional or otherpurposes without my further consent being obtained. Further, I consent to the Event/Activity organisers using my name, image,likeness and also my performance in the Event/Activity, at any time, to promote the Event/Activity by any form of media.
12. Consent to medical treatment: I consent to receiving any medical treatment that the Event/Activity organisers or theirauthorised representatives consider necessary or desirable during or after the Event/Activity.
13. Prevailing conditions: The Event/Activity and the conduct of, and participation in the Event/Activity will be effected by weatherand associated conditions. Given there is often an element of the “luck of the prevailing conditions” in participating and/orcompeting in the Event/Activity I acknowledge and agree the Event organisers cannot control the weather and associatedconditions.
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