CBAC Open Water Festival
Saturday February 7th, 2015
Registration and Waiver Form
(PLEASE READ THIS FORM AND WAIVER CAREFULLY BEFORE SIGNING)
Participants Name(s):
Age : ______
Date of Birth(dd/mm/yy): _____________
Please Circle:
Male
Address:
Phone: (home)
(work)
(cell)
E-mail:
In case of emergency, please contact:
(phone)
Please indicate your selection below for the CBAC Open Water Festival:
1) 5k Swim (ages 11-over ONLY)
____ Individual - $25
2) 600m Swim
____ Individual - $15
3) 200m Lollipop Dash (ages 10-under ONLY)
____ Individual - $15
4) 5k & 600m Swim (ages 11-over ONLY)
____ Individual - $30
SEE REVERSE SIDE FOR WAIVER & SIGNATURE LINE
Female
In consideration of Sport and Recreation Ltd. t/a Camana Bay Aquatic Club ( “CBAC”) permitting me and/or the above-named
minor(s) to participate in the CBAC Open Water Swim (the “Swim”), I, on my own behalf and on behalf of any minor for whom I
am signing, agree as follows:
1.
I understand that CBAC may publish my and/or my child(ren)’s name(s) and image(s) to promote the Swim or may permit
media to publish my and/or my child(ren)’s name(s) and image(s) as part of any reporting of events related to the Swim
including additional open water swim events hosted by CBAC. I understand that my and/or my child(ren)’s name(s) and
image(s) will not be used by CBAC for any other purpose than to promote CBAC or the Swim.
2.
I recognise that there are risks associated with my and/or my child(ren)’s participation in the Swim and may involve the
risk of physical injury or death. I confirm that my and/or my child(ren)’s participation in the Swim is voluntary. I on my
own behalf and on behalf of my child(ren) warrant that I/we are physically fit and have no physical or mental impediment
or condition which would endanger others or my/ourselves by my/our participation in the Swim.
3.
I understand that CBAC reserves the right to refuse me and/or my child(ren) permission to participate for any reason
whatsoever and that I will be refunded any relevant entry fees paid in the event of such refusal. Additionally, I
acknowledge and accept that CBAC reserves the right to change the details of the Swim or cancel or postpone the Swim
without prior notice
4.
I understand that refreshments and food may be provided by a third party and accept that CBAC takes no responsibility for
the suitability or quality of these refreshments and food and they are consumed at my own risk.
5.
Should a medical emergency arise during the Swim, CBAC will make reasonable efforts to notify the designated emergency
contact immediately for consultation. In the event that CBAC cannot reach the designated emergency contact at the given
contact numbers, permission is hereby granted for CBAC to obtain emergency treatment or provide emergency medical
care as deemed necessary. CBAC is not obligated to provide emergency medical care.
6.
I, for myself, my heirs, executors, administrators, successors and assigns and any minor for whom I am signing this waiver
(collectively the “Releasors”) hereby release, waive and discharge from all liability to the Releasors and covenant not to
sue the CBAC, its directors, officers, employees, volunteers and agents (collectively also “CBAC”) for any loss or damage,
and any claim or demands therefore on account of injury to the person or property or resulting in death of me or my
child(ren), whether caused by the negligence of CBAC or otherwise while I am or my child(ren) is/are taking part in the
Swim.
7.
The Releasors hereby agree to indemnify and save and hold harmless CBAC from any loss, liability, damage or cost they
may incur due to the conduct of me or my child(ren) or by my/their failing to observe the rules as established by CBAC for
the Swim.
8.
The Releasors, by signing this Waiver and Consent, understand that they have given up substantial rights, including the
right to sue. The Releasors represent that they have signed this Waiver and Consent freely and that they intend for it to be
binding upon them and a complete release of all liability to the greatest extent permitted by law. The Releasors agree that
if any portion of this Waiver and Release is held to be invalid the balance shall continue in full force.
9.
This Waiver and Consent shall be interpreted and governed in accordance with the laws of the Cayman Islands.
10. The Releasors acknowledge that this Waiver and Consent constitutes the whole agreement as between themselves and
the Club unless otherwise varied in writing.
Signed this
day of
, 2015.
(Print Name)
If signing on behalf of a minor, I am the Parent/Guardian
of the above-named minor(s) and I have authority to sign
this document on their behalf.