Lifesaving society atlantic region time trials championship registration package atlantic region championship time trials
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- ATLANTIC CHAMPIONSHIP TIME TRIALS
- Competitor fee $10.00 / per person Payment
- ATLANTIC REGION CHAMPIONSHIP TIME TRIALS Waiver Release Form Please read carefully before signing 1. Conduct
- Voluntary Assumption of Risk
- Waiver of Liability
- Model Release
- Print name:______________________________ Signature (Competitor) _________________________ Date_______ Signature (Parent or Guardian if under 18)
| 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
Attention: Atlantic Time Trial Registration 14 Purcells Cove Road Halifax, N.S. B3N 1R4 Phone: Fax:
Email: 902 477-6155 902 477-6216
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 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_______ Directory: sites -> default -> files files -> Answer True False 2 points Question 2 files -> Northern England’s set-jetting locations files -> Nstructions for Acquiring Excess Equipment online, through the 1033 Program files -> Occupational health and safety files -> The Black Panther Party’s Ten Point Program files -> International programs roel profile files -> Fermi Questions a guide for Teachers, Students, and Event Supervisors Lloyd Abrams, Ph. D. DuPont Company, cr&D/ccas experimental Station Wilmington, de 19880 files -> Personal Information Name: Maha Al-Ammari Nationality: Saudi Relationship Status Download 20.06 Kb. Share with your friends:
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