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2024 Laps For Lungs Swimmer Registration
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Laps For Lungs
/ 2024 Laps For Lungs Swimmer Registration
TTT 2024 Laps For Lungs Swimmer Registration
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Contact Details
Name
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First
Last
Date of Birth
*
DD slash MM slash YYYY
Email
*
Phone
*
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Event Details
Please indicate what you are registering for:
*
Full Time Swimmer
Team Swimmer
Team Name:
*
Please ensure all swimmers register individually & include the team name.
Please indicate which days you will be attending?
*
Day 1
Day 2
Day 3
All 3 Days
Shirt Size
*
Kids 4
Kids 6
Kids 8
Kids 10
Kids 12
Kids 14
Ladies 6
Ladies 8
Ladies 10
Ladies 12
Ladies 14
Ladies 16
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Ladies 22
Ladies 24
Ladies 26
Mens XS
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Mens 4XL
Mens 5XL
Mens 6XL
Emergency Contact
Emergency Contact Name
*
First
Last
Emergency Contact Phone
*
Emergency Contact Email
*
Extra Details
Dietary Requirements
*
Vegetarian
Vegan
Kosher
Halal
Gluten-free
None
Please list any allergies
Indemnity & Release Acceptance
*
I agree to the Waiver, Release and Liability Discharge Form
• I acknowledge the event is demanding and physical in nature and involves the real risk of serious injury or even death from various causes, including overexertion, equipment failure, dehydration, accidents with other competitors, spectators or road users, weather conditions and/or other causes.
• I understand that participating in the event involves using public and private areas. The hazards include but are not limited to:
o vehicle traffic
o weather conditions
o general road and trail conditions
• I declare, as a condition of entry into the event, that I have undertaken sufficient training for the event and that I am not aware of any illness, injury, physical disability or impairment which may cause me injury or death during or as a consequence of participation in the event. If I do become aware of any medical condition or impairment or am otherwise sick or injured prior to the event, I will withdraw from the event.
• I accept full responsibility for informing myself and assessing all the dangers, hazards and risk of entry in the event and will rely solely on my own assessment of these dangers, hazards and risks before and during my participation in the event.
• The decision to participate in the event is entirely my own and I accept all risks associated with participation in the event, including but not limited to loss of life and/or any injury, including any permanent injury.
• I agree to abide by all event terms and conditions. I understand that I must observe normal traffic rules and obey all directions and instructions given by any officials and the police.
• I acknowledge that it is a condition of participating in this event that I do so at my own risk. I accept all risks necessarily flowing from my participation in the event which could result in loss of life or injury, including permanent injury. I release all persons or corporations associated directly or indirectly with the conduct of the event from and against all and every claim, right or cause of action (including for negligence, breach of contract and/or breach of statute) which I might have or which may arise out of my death or injury and/or damage or loss of any description which I may suffer or sustain as the result of or in connection with my participation in the event. This release continues forever and binds my heirs, executors, personal representatives and assigns and may be pleaded as a bar to any action, claim, demand, suit or legal proceedings.
• I authorise the use of my name, voice, picture or video to be used without payment in any broadcast or communication, promotion or advertising to promote the event or the event Charity now or in the future.
• I have read, understood and voluntarily agree to this Waiver, Release and Liability Discharge Form and explicitly agree to its content.
Payment Details
Laps For Lungs
*
Price:
Price Includes: Registration, Towel, Medal & Swimming Cap
Credit Card
Card Details
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Billing Address
Street Address
Address Line 2
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