Liz Burch Memorial River Swim 2019

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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   Phone #   Address   Emergency contact name   Emergency phone #   Distance Choose one 1.3km Swim 2.6km Swim   Category Choose one 1 Wetsuit Open M/F 10-12 Female 10-12 Male 13-14 Female 13-14 Male 15-17 Female 15-17 Male 18-34 Female 18-34 Male 35-49 Female 35-49 Male 50+ Female 50+ Male Choose one 1 Wetsuit Open M/F 12-14 Female 12-14 Male 15-17 Female 15-17 Male 18-34 Female 18-34 Male 35-49 Female 35-49 Male 50+ Female 50+ Male   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 WAIVER, RELEASE, AND INDEMNITY The following declaration, once acknowledged and made by the swimmer, by way of signing in the space below & paying the swim entry fee, entitles the swimmer to participate in the event. Declaration  In consideration of and as a condition of acceptance of my entry in the TOWSA Open Water Swim (“the Event”) I for myself, my heirs, executors, administrators and legal personal representatives hereby waive all and any claim, right or cause of action which I or they might otherwise have or at any future time have for or arising out of loss of life or injury (including psychological trauma) damages or loss of any description whatsoever (including property damage) which I or my equipment may suffer or sustain in the course of, or consequent upon, my entry or participation in the said event howsoever arising except to the extent prohibited by law.  I hereby release and discharge the Townsville Open Water Swimming Assoc. Inc. together with all persons and corporations involved or otherwise engaged in promoting, staffing or operating the Event together with the servant, agents, representatives and officers of any of them including, (without limiting the generality of the foregoing), sponsor organisations, land owners and lessees, promoters and organisers of the Event, together with their respective directors, officers, employees, consultants, contractors, ,agents, officials and volunteers, from all liability for loss of life or injury, (including psychological trauma), damages or loss of any description whatsoever (including property damage) which I or my equipment may suffer or sustain in the course of or consequent upon my entry or participation in the said Event howsoever arising except to the extent prohibited by law.  I hereby declare that I am medically and physically fit and have undertaken adequate training for the event mindful of the specific route of the course and the duration of the swim.  I hereby agree that in the event of storm, rain, inclement seas or winds, the organisers of the event have the right to modify or cancel the event and the entry fee shall not be refundable. Any swimmers withdrawing from the event or not starting their entry fee shall not be refundable.  All competitor details will be entered into a database. Townsville Open Water Swimming Assoc. Inc., sponsors and/or any of their related entities may use the entrant’s names and official photos for future promotional, marketing and publicity purposes.  I acknowledge that participation in the Event is an activity which is dangerous with many inherent risks as a result of which personal injury (and sometimes death) are common and ordinary consequences. I therefore assume and accept all risk of personal injury or death in any way whatsoever arising from participation in the Event.  By nominating to participate in this meet, I hereby authorize the Swim Director to take whatever action is deemed necessary in the event of an emergency and accept responsibility for any and all costs arising from such action.  I have read, understand and agree to the clinic conditions as set by the organising committee and the swimmer’s declaration.  For the sake of abundant clarity, I, by signing the entry form, without detracting from or limiting in any way, the above points, acknowledge the meaning and import of each, and thereby take full responsibility for my own safety whilst participating in this event. I accept the terms of the waiver Name of parent or guardian who approves this activity