6 Hour Adventure Youth Adventure Race

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Team member   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   Team name Other     Phone #   Address   Emergency contact name   Emergency phone #   City   Category Choose one Female Male Mixed   Event entry fee increases after January 31, 2020 Event entry fee 80.00 NZD

Year at school  *     Name of School or Group  *   Any medical Conditions that we need to be aware of for the Medical crew?  * NoYes   If you answered yes please clearly list any conditions and treatments Support Crew Contact Details - please list Name, E-mail and Cell phone numbers Team Captain Name for this team?  *   Additional Fees if required - please advise us by email exact quantity required of additional fees for the team. I require the additional fee of $20 for a Friday Meal NoYes 20.00 NZD I require the additional fee of $10 for Friday Camping Per Person NoYes 10.00 NZD I require the additional fee of $10 for Saturday Camping Per Person NoYes 10.00 NZD Any additional comments notes? Invoice to be made out to?  *

Total -- Calculate

Please review the waiver provided by the event organizer and click the check box below to accept it. Print waiver GO-4-12 6 Hour Adventure Waiver I/We (the team) declare that I/We have fully read and understood the rules and conditions of the GO-4-12 Adventure Race. I/We attest that I/We am fully aware of the risks and hazards involved in participating in this event and I/We understand that participation in the event is at my/our own risk. In consideration of the acceptance of my/our entry fee, I/We do hereby on behalf of my/our (the team) heirs, executors, administrators and assignees release and forever discharge the sponsors, landowners and any and all persons involved in the conduct of the GO-4-12 Adventure Race from any and all liability whatsoever or claims of damages or actions whatsoever (including negligence) in any manner arising out of my/our participation in the GO-4-12 Adventure Race. I/We agree that the GO-4-12 Adventure Race and any sponsor of this event may use information/photos contained in this entry and event for purposes connected with the event, and to provide details of other products, services and events to me/us from time to time. I/We understand that I/We have rights under the Privacy Act 1993 to access and correct any information held about me/us. I accept the terms of the waiver Name of parent or guardian who approves this activity Please enter your name here