Ocean Blue Waiver Form

Event Waiver & Authority Form

OCEAN BLUE SPORTS - MATARIKI CHALLENGE
Team Details

Team NameClub Name
Age Division*
Gender*
Name #1 *

First NameLast Name
Date of Birth*

MonthDayYear
Date
Phone Number*

Area CodePhone Number
Parent/Guardian Signature

Clear
Signature

Clear
Name #2 *

First NameLast Name
Date of Birth*

MonthDayYear
Date
Phone Number*

Area CodePhone Number
Parent/Guardian Signature

Clear
Signature

Clear
Name #3 *

First NameLast Name
Date of Birth*

MonthDayYear
Date
Phone Number*

Area CodePhone Number
Parent/Guardian Signature

Clear
Signature

Clear
Name #4 *

First NameLast Name
Date of Birth*

MonthDayYear
Date
Phone Number*

Area CodePhone Number
Parent/Guardian Signature

Clear
Signature

Clear
Name #5 *

First NameLast Name
Date of Birth*

MonthDayYear
Date
Phone Number*

Area CodePhone Number
Parent/Guardian Signature

Clear
Signature

Clear
Name #6 *

First NameLast Name
Date of Birth*

MonthDayYear
Date
Phone Number*

Area CodePhone Number
Parent/Guardian Signature

Clear
Signature

Clear

Please note any Medical Conditions Here
Please type name of the paddler and medical condition
I declare that:

1.My accepted entry will not be transferred to another entrant.

2.In the event of any “act of God” conditions causing a cancellation of the event, my total
entry fee is not transferable or refundable.

3.I acknowledge that there are risks involved with Waka Ama and fully realise the dangers of participating in an event such as this and fully assume the risks associated with such participation and my wellbeing during the event.

4.I understand and agree that situations may arise during the event, which may be beyond the immediate control of ofﬁcials or organisers, and I must continually participate in a manner that does not endanger either myself or others.

5.Neither the organisers, the sponsors nor other parties associated with the event shall have any responsibility, ﬁnancial or otherwise, for any risk incident that might arise, whether or not by negligence, from any direct or indirect loss, injury or death that might be sustained by me or any other party directly or indirectly associated with me, from my intended or actual participation in the event or its related activities.

6.I authorise my name, voice, picture and information on this entry form to be used without payment to me in any broadcast, telecast, promotion, advertising, or any other way pursuant to the Privacy Act 1993.

7.I agree to comply with the rules, regulations and event instructions of (name of event).

8. I consent to receiving medical treatment which may be advisable in the event of illness or injuries suffered during the event.

9.I confirm that I can swim 50 Metres/OR if I cannot swim 50 Metres I will wear a PFD during the race

*** If the competitor is under 18 the waiver must be signed by a parent or guardian ***
Should be Empty:

Event Waiver & Authority Form