Paddling for Change
18 July 2021
6:00AM - 4:00PM
Date of Birth
Street Address Line 2
State / Province
Postal / Zip Code
Emergency Contact Person
Emergency Person Phone Number
Relationship to Emergency Contact Person
I am entering
If you are entering as a team, please provide your team members names and cell numbers
Waiver & Release
I confirm that I am in good shape, health, and condition.
I don't have any medical condition or medical history that will affect my participation in this event.
I will follow the rule and regulations of SHongweni67
I acknowledge that this challenge requires physical activity and there are possible risks and danger.
I release the Shongweni67 event organizers for any responsibility in case of an accident, illness, or injury.
I allow my photo to be taken during the event and used for event advertising and marketing.
I confirm that all information in this registration form is accurate and true.
I acknowledge that it is my responsibility to raise my entry fee of R2000 (team/individual). Shongweni 67 will issue me with marketing material and I will utilize this to attract investment.
Parent/Guardian Signature (If participant is below 18 years old)
Should be Empty:
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