SRI PETALING BRANCH.
Fancy Dress Charity Fun Walk - Entry Form
Sunday 26th July 2015......... 7am-10am
- You must present this completed form to participate. Families can enter on one form as long as your details are the same (max 4 per family)
!. Name: …………………………………………...........…..
Birth date: ……………………Male / Female
2.Name …………………………………................……….
Birth Date .... ………………. Male / Female
3.Name…………………………………...............……….
Birth date: …………………. Male / Female
4.First Name……………………………………
Birth date: …………………. Male / Female
Address…………………………………………………………………………………………………
..........................................................State……………………Post Code……… Mobile………………………………….. Email………………………………………………………………..
FANCY DRESS CHARITY DAY Event: Participant Agreement
I agree to the following as conditions of participating in the Fancy Dress Charity Fun Walk.
• I acknowledge that: I participate in the Event at my own risk.
I will take all reasonable measures to protect myself from the risks of participation.
I accept all responsibility for travel and medical insurance and for payment and/or reimbursement of medical/surgical expenses incurred on my behalf.
I am responsible for all property I bring to the Event site and that the organisers accept no responsibility for any loss or damage to this property.
• I release The Organisers (and their directors, officers, employees, volunteers, contractors, sponsors and / or agents) from any claim and from any liability (to the extent permitted by law) for or as a result of any loss, injury or damage suffered by me in relation to my attendance and participation at the Event, how so ever caused, including any claim or liability which arises due to any negligence of The Organisers
(and / or their directors, officers, employees, volunteers, contractors, sponsors and / or agents).
• I consent to the publication and/or use in any form of media whatsoever of my name, race result, image, voice, statement or otherwise,including the publication of my name and/or event result and applicable age bracket in /or marketing materials/website without payment or
compensation.
• To the best of my knowledge, I am not suffering from a condition which would prevent and/or render me unfit to participate in the Event.
________________________________________________
Signature of entrant or guardian if the entrant is under 18yrs
Event Timetable
Event to start at the Sales Deck , White Crystal and finish at Jack Frost (Arco).
11:00am Registrations open 11.45 Registrations close.
12 noon Competitor briefing
12.30 Fun walk commences
BBQ at finish line (Arco)
1:30pm Presentations at Arco (Jack Frost)
Phone Angela 57593550 for event information.
Rules
• Entry is $20 per entrant. Families $40. School group or organisation $200. Student $10pp .
• We recommend you submit entry forms early
• Prams and Strollers will be permitted upon favourable weather conditions.
• No Alcohol, Bikes, Scooters, Rip Stiks, Roller Blades, Skates or other like items.
• Personal music devices are strongly discouraged.
PO Box 188 Bright 3741 Victoria Australia
Phone 03 5759 3550 - Fax 03 5759 3693
Email angelamelaney@mthotham.com.au - Website www.mthotham.com.au
www.mthotham.com.au
DECLARATION, WAIVER AND INDEMNITY.
This is to be read and signed in conjunction with participating in the Fancy Dress Charity Fun Walk to be held on Saturday September 6th, 2014.
In consideration of accepting this entry and allowing myself to participate in the 2014 Camp Quality Fancy Dress Charity Fun Walk (Event), I the undersigned
(for myself, my heirs, executors and administrators or agents) agree with the Organisers and Event Sponsors and/or agents that:
1. I waive, release and discharge the Fancy Dress Charity Fun Walk (Organisers) and the event sponsors and each of their respective officers employees and
volunteers involved in the Event from all claims or causes of action I may have (including for negligence) arising from any injury, loss or damage of any kind
suffered by me including personal injury, illness or death and/or loss or damage to any property arising either directly or indirectly out of my attendance at or
participation in the Event.
2. I indemnify and will keep indemnified the Organisers and Event Sponsors against all costs, losses or damages arising from or in relation to my attendance at
or participation in the Event including the attendance or participation of any person in my care.
3. I declare that I am physically fit to participate in and complete the Event.
4. I consent to the free use of my name and pictures of me by the Organisers and/or the Event Sponsors in relation to the Event.
5. I agree to obey and accept the Event rules and any other instructions (whether announced on the day or otherwise).
6. I agree that Fancy Dress Charity Fun Walk Organisers reserves the right to refuse entry into the fun walk or to disqualify my participation during the event on
any grounds
7. I consent to receive and agree to pay for any medical treatment (including transport by ambulance) which is considered in the reasonable opinion of the
Event Organisers to be advisable, before, during or after the Event.
8. I attend and participate in the Event exclusively at my own risk and at all times I have the option of not participating in or withdrawing from the Event at any
time.
9. Entrants under the age of 18 must obtain the prior permission of a parent or guardian over the age of 18 to enter.
10. In consideration for the Organisers awarding the prize to the winner, the winner hereby permits the winner’s image and/or voice, as recorded,
photographed or filmed during the winner’s participation in the prize to appear in connection with the Fancy Dress Charity Fun Walk, the advertising or
marketing thereof, in any media whatsoever throughout the world and the winner will not be entitled to any fee for such use.
11. In the case of the intervention of any outside act, agent or event which prevents or significantly hinders the Organisers ability to proceed with the
competition on the dates and in the manner described in these terms and conditions, including but not limited to weather conditions, vandalism, power
failures, tempests, acts of God, the Organisers may in their absolute discretion cancel the competition .
12. The Organisers and Prize providers shall not be liable for any loss or damage whatsoever which is suffered (including but not limited to indirect or
consequential loss) or for any personal injury suffered or sustained in connection with any prize/s except for any liability which cannot be excluded by law.
The Organisers are not responsible for any incorrect or inaccurate information, theft or destruction or unauthorised access to or alteration of entries.
13. The Organisers reserve the right in their sole discretion to disqualify prior to or during the event, any individual or team who the Organisers have
reason to believe have breached any of these conditions, (including health reasons) or engaged in any unlawful or other improper misconduct calculated to
jeopardise the fair and proper conduct of the Event.
14. All entries become the property of the Organisers. The Organisers collect personal information about you to enable you to participate in this promotion but no further use of this information will be made without prior consent.
15. By entering the Event, unless otherwise advised, each entrant also agrees that the Organisers, and any other associated agency and companies in
conjunction with the Event may use this information, in any media for future promotional, marketing and publicity purposes without any further reference,
payment or other compensation to the entrant, including sending the entrant electronic messages.
16. The Fancy Dress Charity Fun Walk Organisers, are collecting the entrant's personal information for the purpose of conducting and promoting this
Event (including but not limited to determining and notifying winner). If you are not willing for this to occur you cannot participate in the Event.
17. I hereby acknowledge that I have read, understood and accept these terms and conditions and agree to be bound by them in relation to my
attendance at and participation in the Event.
18. The judge’s decision is final and no disputes will be entertained.
Name: ............................................................................................
Signature: .........................................................................................
Date:: ............................
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