Nationals 2010 Invitation to Athletes
July 17 & 18, 2009, Red Deer, Alberta
NAME_____________________________B/D
day______month______year_________
M
F
ADDRESS
_______________________________________________________________________
POSTAL
CODE________________EMAIL(required for correspondence and
updates)____________________
NAME OF TEAM MANAGER, CHAPERONE OR
COACH (staying with/or responsible for athlete)
____________________________________________ PHONE NUMBER
__________________________
VERIFICATION OF ABILITY TO
RIDE_________________________________________________________
SIGNATURE OF RIDING COACH WITH PRINTED NAME AND PHONE NUMBER*
*If riders are deemed incapable of completing the course safely, they will be removed at the discretion of the TD, without recourse, in the warm up ring.
CONTACT IN CASE OF EMERGENCY ____________________PHONE
NUMBER_________________
Entry Fees:
ATHLETE (NON RIDER) ENTRY FEE: $ to come
ATHLETE (RIDER) (Includes Senior, Junior, & Masters) ENTRY FEE: $ to come
SENIOR (>22 years) JUNIOR
(19–21
years) YOUTH A (17-18
years) YOUTH B (15-16
years)
YOUTH C (13-14 years)
YOUTH D (11-12
years) YOUTH E (<10
years) MASTERS (Men>40
years, Women>35 years)
Swim Time:_______ (Senior, Junior,
Youth A & B 200 meters, Youth C & Masters 100 meters, Youth D & E 50
meters) Please note ALL age groups
will use the combined (shoot/run) format.
*Requests
to move up a division(s) to ride will be subject to available horses and at the
discretion of TD of the Ride, Rick Maynard. If horses become unavailable, due to
unforeseen circumstances, Masters will not ride, and be reimbursed the riding
fee.
Meals Included:
to come:
Breakfast, Lunch & Banquet
Tee Shirt Included: Please Indicate
Size: S
M L
X/L
Supporter (Parent, Coach) FEE: $
to come (August 23 Breakfast, Lunch & Banquet)
Additional Tee Shirt: FEE: $$
to come Please Indicate Size S M
L X/L
Please include any dietary
restrictions:___________________________________________________________
Please Make Cheques Payable To:
Maple Ridge Modern Pentathlon Association
LATE FEE: Additional $150.00 after to come.
No registrations will be accepted after to come.
Send Registration Form,
Waivers and Cheque (payable to: MRMPA) to:
Bob Noble
PHONE: 604-619-7653
EMAIL: ranoble@shaw.ca
Transportation: Info coming soon
YYC arrival flight date and
time:_________________________YYC departure date and time___________________
Tentative Schedule
Arrival of Athletes, Coaches, Supporters
Equipment Requirements
The organizing committee asks that athletes compete in the proper attire:
Fencing
· Fencing whites must be worn, NO sweat/track pants. Athlete’s surname and nation code on the back of the fencing jacket. 800N Jacket, 800N Plastron, 800N Breeches, 1600N helmet and knee socks required as per CAMPA policy for seniors, juniors, masters and youth A.
· Spare Body Wire
· Spare Epee
Swimming
· Swimwear in good condition
Running
· Shirt or singlet must be worn with athlete’s surname and nation code on the back. The run course is grass and cinder track, however the shoot is on an asphalt basketball court, spikes are NOT recommended.
Riding
· Breeches, Jacket & Tie for men, Breeches, Jacket & blouse for women
· Riding boots with heel
· ASTM approved Helmets are mandatory
Accommodation:
Please quote Canadian Modern Pentathlon Championships for group rate: $ to come per night. T
WAIVER
Covering all Modern Pentathlon Competitions,
Local, Provincial, National and International
I am aware that modern pentathlon involves many
inherent risks, dangers and hazards, including but not limited to, the use and
operation of air pistols, fencing equipment, equestrian equipment, horses and
obstacles, cross-country running terrain with associated hazards, negligence on
the part of event organizers, event volunteers, coaches, other athletes and
spectators.
I freely accept and
fully assume all such risks, dangers, and hazards and the possibility of
personal injury, property damage or loss resulting from such risks, dangers, and
hazards. In consideration of The
Canadian Modern Pentathlon Association or the Maple Ridge Modern Pentathlon
Association allowing me to take part as a manager, coach or athlete in Modern
Pentathlon competitions, whether they be local, provincial, national or
international, (hereafter referred to as “the Competitions”), I hereby agree
as follows:
- TO ASSUME AND ACCEPT ALL RISKS, DANGERS AND HAZARDS in connection with my participation in, and/or travel to or from, the Competitions;
- TO WAIVE ANY AND ALL CLAIMS that I may have against the Canadian Modern Pentathlon Association and the Maple Ridge Modern Pentathlon Association, its directors, officers, employees, agents and representatives (all of whom are collectively referred to as “CAMPA” and “MRMPA”);
- TO RELEASE CAMPA/MRMPA from any and all liability for any loss, damage, injury or expense that I, or my next of kin, may suffer or incur as a result of my participation in, and/or travel to or from, the Competitions, due to any cause whatsoever, INCLUDING NEGLIGENCE ON THE PART OF CAMPA or the host province British Columbia;
- TO
HOLD HARMLESS AND INDEMNIFY CAMPA/MRMPA from any and all liability for property damage
or personal injury suffered by myself or by a third party as a result of my
participation in, and/or travel to or from, the Competitions.
I have read and understood this Waiver prior to signing it and am aware that by signing this document, I am accepting the terms of this Waiver and am thereby affecting the legal rights and liabilities of myself, my family, administrators and assigns in relation to CAMPA and the host province British Columbia/ I confirm that I am over the age of majority in my Province.
(For those under the age of majority in their
Province) I understand that my parent or guardian is required to sign this
Waiver before I can participate in any competition under the auspices of Modern
Pentathlon.
Signature of Athlete_________________Print Name_________________________
Signature of Parent__________________Print Name_________________________
Address: ____________________________________________________________
Date: ____________________, 2010
Each
person taking part in Modern Pentathlon competitions under the auspices of CAMPA
and/or a provincial organization must complete this form.
RELEASE AND
WAIVER OF LIABILITY, ASSUMPTION OF RISK
AND
INDEMNITY AGREEMENT
WHEREAS:
A.
The Maple Ridge Modern Pentathlon
Association, in conjunction with the Canadian Modern Pentathlon Association (the
“Association”) is the organizer of the Canadian National Championships which
is being held in Red DeerAlberta on July 17 & 18, 2010 (the “Event”);
B.
The Event includes an equestrian component during which
the participants will handle or ride unfamiliar loaned horses (the “Equestrian
Activities”);
C.
The Equestrian Activities will take place at Northside
Stables (the “Equestrian Venue”); and
D.
I wish to participate in the Event, and in particular,
in the Equestrian Activities.
Assumption
of Risks
- I understand that horses can
act unexpectedly at times, and acknowledge the inherently hazardous nature
of being around or riding, saddling, unsaddling, grooming, feeding or caring
for horses;
- I am aware that being around
horses or participating in any manner in the Equestrian Activities,
including as a spectator, involve many inherent RISKS, DANGERS or HAZARDS,
including but not limited to: falling off or being struck or bitten by
horses, encountering ditches, fences, streams, roads and other obstacles,
whether man or nature made, exposed rocks, mud, ice, trees, bushes or other
natural objects while riding or being around horses, variations in weather
or riding surface, colliding against or encountering horses or other
animals, riders, vehicles or other moving objects, colliding against walls,
riding rings, jumps or other objects, failure, loosening or breakage of
bridles, lead hopes, halters, saddles, girths, helmets or other tack and
equipment, failure to ride or interact with horses safely or within one’s
own ability or within designated areas or in accordance with standard
practice, local rules or regulations, negligence of other riders or persons
at the Equestrian Venue or participants in the Equestrian Activities
(collectively, the “Risks, Dangers or Hazards”), or NEGLIGENCE ON THE
PART OF THE ASSOCIATION OR THEIR OFFICERS, DIRECTORS, EMPLOYEES, STAFF AND
VOLUNTEERS, INCLUDING THE FAILURE TO SAFEGUARD OR PROTECT ME FROM THE RISKS,
DANGERS OR HAZARDS.
- I acknowledge and agree that
the Risks, Dangers or Hazards exist whenever and wherever the Equestrian
Activities occur, notwithstanding that they may not be obvious or apparent
to me.
- I acknowledge and agree that
the Risks, Dangers or Hazards are magnified as a result of the nature of the
Equestrian Activities, which involve the use of an unfamiliar horse and
unfamiliar equipment, and as a result of the failure on the part of the
owner(s) of said horse to warn me in relation to any issues regarding the
horse or its equipment.
-
I acknowledge and agree that,
in registering for the Event and for the Equestrian Activities, I am
representing to the Association that I possess the requisite level of skill
to safely participate in same. I also acknowledge and agree that,
notwithstanding the Association’s overriding discretion to deny
participation or continued participation in the Equestrian Activities to
anyone who appears not to possess a minimum level of skill to safely
participate in same, the Association has no obligation to do so. In
particular, I acknowledge and agree that, in allowing me to participate or
continue to participate in the Equestrian Activities, the Association is not
warranting or representing that I possess the minimum level of skill to
safely to do.
Waiver
of Claims, Release of Liability and Indemnity
- IN CONSIDERATION OF AND AS A
CONDITION OF the Association allowing me to participate in any manner
whatsoever in the Equestrian Activities, AND IN CONSIDERATION OF AND AS A
CONDITION OF the “Owner” allowing me to use their horse (the “Loaned
Horse”) in the Equestrian Activities, I agree as follows:
- To release, waive, discharge
and covenant not to sue the Association and its officers, directors,
assigns, employees, staff, servants, volunteers and agents, and their
successors, predecessors, subsidiaries and associated companies or
entities, the Owner and the Owner’s heirs, executors, administrators,
successors and assigns, and the owners or managers of the Equestrian
Venue, as well as their insurers (collectively, the “Releasees”) from
any and all liability FOR ANY LOSS OR DAMAGE OR EXPENSE, AND ANY CLAIM OR
DEMANDS ON ACCOUNT OF INJURY TO THE PERSON OR PROPERTY OR RESULTING IN
DEATH, ARISING OUT OF OR RELATED TO MY PRESENCE AT OR USE OF THE
EQUESTRIAN VENUE AND OR THE LOANED HORSE OR MY PARTICIPATION IN THE
EQUESTRIAN ACTIVITIES, DUE TO ANY CAUSE WHATSOEVER, INCLUDING NEGLIGENCE
OF THE RELEASEES, BREACH OF CONTRACT AND BREACH OF ANY STATUTORY OR OTHER
DUTY OF CARE, INCLUDING ANY DUTY OF CARE OWED PURSUANT TO THE OCCUPIERS
LIABILITY ACT, R.S.B.C. 1996, c. 337.
- To indemnify and hold the
Releasees and each of them harmless FROM ANY AND ALL LIABILITY FOR ANY
LOSS OR DAMAGE OR EXPENSE to property or personal injury arising out of or
related to my use of the Loaned Horse or the Equestrian Venue or
participation in the Equestrian Activities, WHETHER CAUSED BY THE
NEGLIGENCE OF THE RELEASEES OR ANY OF THEM OR OTHERWISE.
General Provisions
- This Release and Waiver of
Liability, Assumption of Risk and Indemnity Agreement (the “Agreement”)
shall be effective and binding upon my heirs, next of kin, executors,
administrators, personal representatives, successors and assigns and all
persons claiming for, or through me.
-
In the event that I am unable
to use the designated Loaned Horse for any portion of the Equestrian
Activities, and am assigned a substitute horse, I acknowledge and agree that
this Agreement also applies for the benefit of the owner(s) of the
substitute horse, who shall be deemed included in the definition of
“Owner” in paragraph 6 of this Agreement.
- This Agreement and any rights,
duties and obligations as between the parties to this Agreement shall be
governed by and interpreted solely in accordance with the laws of the
- Any litigation involving the
parties to this Agreement shall be brought solely within the
- In entering into the Agreement, I am not relying upon any oral or written representation or statements made by the Releasees, and acknowledge and agree that this Agreement contains the entire agreement between the parties hereto, and that the terms of this Agreement are contractual and not mere recitals.
BY
SIGNING THIS RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY
AGREEMENT I UNDERSTAND THAT I HAVE WAIVED SUBSTANTIAL RIGHTS, INCLUDING THE
RIGHT TO SUE THE RELEASEES IN RESPECT OF BODILY INJURY, DEATH OR PROPERTY LOSS.
Signed on the ________ day of ________________, 20010
__________________________
___________________________
Witness’ Signature
Athlete’s Signature
__________________________
___________________________
Witness’ Printed Name
Athlete’s Printed Name
__________________________
___________________________
Witness’ Address
Athlete’s Address
