Totara360 2019

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A Team   First name   Last name   Email address   Age on event date 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 Gender -- Male Female   Team name Choose one Crazy High Rollers Padyak NZ Other     Club name Choose one Totara Park MTB Club Other     Phone #   Emergency contact name   Emergency phone #   Distance Choose one 3 Hour 6 Hour   Category Choose one Solo Choose one Junior School (Y8-10) Senior School (Y11-13) Single Speed Solo 40+ Solo Open Team 40+ Team Open   Event entry fee TBD

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Please review the waiver provided by the event organizer and click the check box below to accept it. Print waiver By signing this application you agree that: • You were 18 years or older on the most recent 1 July (if you were not, this form must be completed by your legal guardian). • If you are completing this form on behalf of a family or a junior member, you agree to each of the following points on behalf of your family/junior. • You are fully aware of the risks of cycle sports and participating in cycling events including the risks of property damage, physical injury and death. • You are responsible for deciding whether you/your family/junior are fit and healthy enough and whether your bicycle and other equipment is adequate to safely participate in cycle events. You participate at your own risk. • To the maximum extent permitted by law, the event organizer (including its agents, representatives, organizers and sponsors) will not be liable to you for any loss, damage, personal injury action, claim, costs or expenses you may suffer (to person or property) as a direct or indirect result of participating in any activity that the event organizer promotes, advertises or has any association with. • The event organizer can use (and can authorize any third party to use) photographs, video, recordings, data or any other record of your participation in any event for any legitimate purpose and you waive your rights to receive payment. • When participating in this event you will comply with any rules relevant to the event and you acknowledge that you can be refused access to the event if you engage or have engaged in any behavior the event organizer considers to be cheating or which brings the event into disrepute I accept the terms of the waiver Name of parent or guardian who approves this activity Please enter your name here