Lifesaving society atlantic region time trials championship registration package atlantic region championship time trials



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LIFESAVING SOCIETY ATLANTIC REGION TIME TRIALS CHAMPIONSHIP REGISTRATION PACKAGE
ATLANTIC REGION CHAMPIONSHIP TIME TRIALS
Registration Package
The Lifesaving Society invites you to the Atlantic Region Championship Time Trials
DATE: Feb. 4, 2012
LOCATION Dalplex Pool – Halifax, Nova Scotia
COMPETITION The competition is sanctioned by the Lifesaving Society and will be run as Long Course. Event Rules will be in accordance with the 2011 Edition of the ILS Competition Manual. Go to www.lifesavingsociety.com for all information.
ELIGIBILITY National Team Selection Criteria – hold a current Bronze Medallion, Bronze Cross or National Lifeguard Service certification; registered athlete; Canadian citizen; minimum of 16 years of age as of the appointment date of June 5, 2012.
EVENTS

100m Manikin Carry with Fins

50m Manikin Carry

200m Super Lifesaver

100m Tow with Fins
ENTRY DEADLINE Complete entries must be received by Feb. 2, 2012 5:00pm AST. Refunds will not be issued after Feb. 3 nor will they be issued for those who do not attend.
ENTRY FEES Competitor Fee: $10 per each competitor
REGISTRATION Submit Registration Form with payment in full being received prior to competing at the Event. Purchase Order, Cheque (payable to the Nova Scotia Lifeguard Service), money order to:
Nova Scotia Lifeguard Service

Attention: Atlantic Time Trial Registration

14 Purcells Cove Road

Halifax, N.S. B3N 1R4

Phone:

Fax:


Email:

902 477-6155

902 477-6216

paul.deon@nsls.ns.ca

LIFESAVING SOCIETY ATLANTIC REGION TIME TRIALS CHAMPIOSHIP REGISTRATION PACKAGE



ATLANTIC CHAMPIONSHIP TIME TRIALS

Feb. 4, 2012 Dalplex Pool, Halifax, Nova Scotia


4:30-5:00PM Athlete Check In

5:15 PM Warm Up

5:15 PM Officials Meeting

5:30 PM Events

100 m Manikin Carry with Fins

50 m Manikin Carry

200 m Super Lifesaver

100 m Tow with Fins


Approx. 8:00 PM Finish

Please use one form for each competitor (Type or BLOCK letters only)


Club or Affiliate:
First Name: Last Name:
Age: Birth Date: (yr/month/day)____/____/____ Sex: M___ or F___
Mailing address Apt or Suite:
City:
Province:
Postal Code:
Email:
Phone Number
100m Carry with Fins ( )

50m Manikin Carry ( )

200m Super Lifesaver ( )

100m Tow with Fins ( )


Check events you wish to enter.
Competitor fee $10.00 / per person
Payment

Cash, Cheque; Money order; P.O. #


Mail, fax or email to:

Nova Scotia Lifeguard Service

Attn: Atlantic Time Trial Registration,

14 Purcells Cove Road, Halifax, N.S. B3N1R4

Email:paul.deon@nsls.ns.ca fax:902-477-6216
LIFESAVING SOCIETY ATLANTIC REGION TIME TRIALS CHAMPIONSHIP REGISTRATION PACKAGE

ATLANTIC REGION CHAMPIONSHIP TIME TRIALS

Waiver & Release Form

Please read carefully before signing
1. Conduct
I agree to abide by the rules, regulations and code of conduct of the championship, and further to behave in a manner consistent with ideals of good sportsmanship.
2. Voluntary Assumption of Risk
As a competitor in a lifeguard competition, I recognize that there are certain risks inherent in the activity as a result of factors including but not limited to, stress, number of people, water temperature and conditions. I have prepared myself for the competition and know of no factor or condition which should be disclosed to the organizers or which would make it unsafe for me to compete. I voluntarily assume all risks, both physical and legal including but not restricted to, loss of or damage to property, and personal injury including permanent disability or death.
3. Waiver of Liability
As a condition of entry and in consideration of my application as an individual or as a part of a team being accepted, I hereby waive my right to make any claim, whether for negligence or otherwise against the Lifesaving Society, the host, the facility operator, owner or occupier, the sponsors, the organizing committee or any of the servants, agents, affiliates, volunteers, judges, officials or other persons involved in the organization or running of the competition, events or associated activities. I further agree to indemnify and hold harmless all of the above, from any claim made on my behalf or as a result of injury to my person or property. I recognize that competitors are responsible for their own medical coverage.
4. Model Release
I transfer to the Lifesaving Society all rights whatsoever which I have in photographs and/or videos which photographers may have taken. I consent to the use of the photographs/videos, the publishing of my name for all purposes whatsoever, including without limitation, television, publications, and any trade or advertising purposes.
I have carefully read and understood the four conditions of entry and in consideration for being allowed to compete, I have executed them voluntarily intending to be bound thereby and intending these conditions to be binding of my heirs, personal representatives and assigns.
Print name:______________________________

Signature (Competitor) _________________________ Date_______
Signature (Parent or Guardian if under 18)

________________________________ Date_______


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