Bendigo Bank Agnes Water Triathlon - Enticer

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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 2020 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    Gender -- Male Female   Hometown Other     Team member names Other     Phone #   Address   Emergency contact name   Emergency phone #   City   Zip code / Postal code   State / Province   Triathlon Races Choose one Enticer Enticer Team   Events Choose one 16 yrs and over Current Triathlon Australia Member Non - Triathlon Australia Member Non Triathlon Australia Member Under 16 yrs on event day Choose one Non Triathlon Australia Member   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 WARNING: This is a legal document that affects your rights. 1. I acknowledge that competitive multisport involves the real risk of serious injury or even death from various causes including overexertion, equipment failure, dehydration, and accidents with other competitors, spectators or road users, course or weather conditions and other causes. 2. I understand that I should not compete in this event unless I have trained appropriately and a medical practitioner has verified my physical condition. 3. By competing, I accept all risks necessarily following from my participation that could result in loss of life or permanent injury. Accordingly, I release all persons or corporations associated directly or indirectly with the conduct of the event from all claims demands and proceedings arising out of my participation and I hereby indemnify them against all liability (including liability for their negligence and the negligence of others) for oil injury, loss or damage arising out of or connected with my participation in this event. This release shall extend to and include the Agnes Water Triathlon Inc Organisers and Volunteers, Triathlon Australia Inc., Triathlon Queensland Inc, and their respective directors, partners, managers, officers, agents, contractors, employees and volunteers including medical and paramedical personnel appointed for the event, the owners, licensees and occupiers of land upon which the event or any part of it is conducted, any statutory body or local authority having control over land upon which the event or any part of it is conducted or which is involved directly or indirectly with the event in any manner whatsoever and promoters, sponsors and event organisers. This release and indemnity continues forever and binds my heirs, executors, personal representatives and assigns. 4. I consent to receiving any medical treatment including ambulance transportation that the event organisers think desirable during or after the event. 5. I consent to event organisers using my name, image and likeness before, during or after the event for event promotional broadcasting or reporting purposes in any media. 6. I understand that compulsory insurance cover affected for participants in this event may not cover me for any or all injury, loss or damage sustained by me. 7. Safety precautions undertaken by organisers (such as course supervision, race safety briefings, bicycle and helmet safety checks) are a service to me and other competitors but are not a guarantee of safety. 8. I am fully responsible for the security of my personal possessions at the event. 9. My registration is not transferable to other people. If I am unable to complete, or if the event is cancelled by way of circumstances beyond the control of the event directors, my registration fee is non-refundable. 10. I acknowledge that upon completing this Registration I must advise the Event Organiser by email admin@agneswatertriathlon.com of any medical and/or physical condition from which I suffer that might affect my performance or be relevant if medical treatment needed. I accept risk of competing, despite these conditions. 11. I agree to abide by all race rules and directions issued by Triathlon Australia and the event organiser. 12. Event organisers may change the event format, course or other race conditions of their discretion. If that occurs, this agreement applies to the changed conditions. I accept the terms of the waiver Name of parent or guardian who approves this activity