Watermans to the Wall - 28th April 2019

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Who are you registering? Choose one Yourself Someone else Team

Team name   First name   Last name   Email address   Date of birth DD 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31    MM 01 02 03 04 05 06 07 08 09 10 11 12       YYYY 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920    Gender -- Male Female Female/Male   Enter team member names if applicable Other     Phone #   Emergency contact name   Emergency phone #   City   State / Province   Country   Individual or team Choose one Individual Team   Category Choose one Over 16 female Over 16 male Under 16 female Under 16 male Choose one Team   Event entry fee TBD

What is your expected time in hh:mm:ss for the 2.7km swim  *   Medical conditions (for indiv. or teams)  *

Discount or coupon code Subtotal -- Discount -- Total -- Calculate

Please review the waiver provided by the event organizer and click the check box below to accept it. Print waiver Participant Declaration: "Club" for the purposes of this declaration means and includes the Sorrento Surf Life Saving Club Inc, Surf Life Saving Western Australia Inc and their respective directors, officers, members, volunteers, servants or agents. Warning: Participation in the Event can be inherently dangerous. Serious accidents can and often do happen which may result in me being injured or even killed. I have voluntarily read and understood this warning and accept and assume the inherent risks in participating in the Event. Entry Prerequisite: I declare that I have undertaken sufficient training and have acquired a level of fitness and surf knowledge necessary to complete this race. Exclusion of Liability: Except where provided or required by law and such cannot be excluded, I agree that it is a term of my entry in the Event (if accepted) that the Event Organiser and the Club are each absolved from all liability however arising from injury or damage (whether fatal or otherwise) however caused (including by the negligence of the Event Organiser or the Club) arising out of my participation in the Event. Release and Indemnity: In consideration of my application for entry in the Event being accepted I: (a) release and forever discharge the Event Organiser and the Club from all claims that I may have or may have had but for this release arising from or in connection with my participation in the Event; and (b) indemnify and hold harmless the Event Organiser and the Club to the extent permitted by law in respect of any claim by any person including but not only another participant in the Event arising as a result of or in connection with my participation in the Event. I agree to, abide by and accept the rules and regulations of the Event and to accept the decisions of the Race committee. I consent to the free use of my name and photograph in any newspaper advertising material, video or telecast by the Event organiser and/or its sponsors. I have read, understood, acknowledge and agree to the above declaration including the warning, exclusion of liability, release and indemnity. I accept the terms of the waiver Name of parent or guardian who approves this activity