ENTRY FORM - Mud and Sweat

ENTRY FORM
PLEASE FILL IN
FULL NAME:
EVENT ENTERED:
NIGHT RIDER EVENT
th
Lanhydrock 10 December 2016
COURSE ENTERED:
GENDER (Please Delete):
DATE OF BIRTH:
ADDRESS:
MALE
LONG
FEMALE
AGE (On Event):
SHORT
POST CODE:
HOME TELEPHONE:
MOBILE NUMBER:
EMAIL (Please ensure legible):
EMERGENCY CONTACT NAME:
EMERGENCY PHONE NUMBER:
Declaration:
I hereby apply to participate in the above event. I acknowledge that Mountain Biking can be hazardous and
accept and agree that neither the Organisers, Officials, Marshals and their Agents, Landowners, Sponsors nor
fellow participants shall be liable in any way, or in any circumstances for any damage, injury or loss to me or to
my party that may occur during, in connection with, or as a result of taking part in the event. We do suggest
participants consider obtaining insurance cover for their sporting endeavours.
I agree that I participate in the event entirely at my own risk and that I am physically fit and able to compete,
that I will ride within my capabilities, obey instructions given by marshals and ride in a manner which is safe for
myself and others. My bicycle is in good working order and properly maintained and I will be suitably equipped
to deal with mechanical breakdowns and inclement weather. I have read and understood the rules and
regulations, and terms and conditions of the event (available as a download from www.mudandsweat.com).
I agree to the conditions as stated:
SIGNATURE: (Over 18’s Only)
16 and 17 Year Olds
Parent/Guardian Must Sign
DATE:
I ENCLOSE MY PAYMENT OF £26 for the Event
Or I have paid Online – Please include PayPal Transaction Reference
Please either Post this form, along with a cheque for your entry fee to:
WAY AHEAD, 2 Valleyside, West Buckland, Kingsbridge, Devon, TQ7 3AE
(All cheques should be made payable to Way Ahead)
Or pay Online and Email the completed form to: [email protected]
www.mudandsweat.com
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MUD AND SWEAT NIGHT RIDER WAIVER AND CONSENT FORM
In consideration of Way Ahead (Mud and Sweat) allowing the Participant to take part in the Night Rider (the "Event") each Participant hereby agrees as follows:
1. I acknowledge that:
(i) The Event is physically strenuous and my signature below confirms that I have read and reviewed the details of what participation in the Event entails as is set out on
Mud and Sweat’s website www.www.mudandsweat.com;
ii) Participation in the Event will be physically demanding and may involve, but shall not be limited to, various modes of physical activity including: mountain biking over
difficult terrain by day and night;
ii) I am fully aware of and accept the various medical, physical and emotional risks which are inherent in such activities and which include but are not limited to:
sprains; fractures; illness and/or infection; heat and cold injuries; over-use syndrome; injuries involving vehicles; animal bites and/or stings and/or allergic reactions;
contact with poisonous plants; accidents involving other Participants and/or spectators, Mud and Sweat personnel and/or the potential for permanent paralysis or
death and property loss and/or damage.
2. I confirm that I have answered the following questions in advance of attending the Event and in the instances where I have answered “yes” to any of the questions, I
have sought medical advice as to my participation in the Event and informed Mud and Sweat of the complaint or condition:
Have you ever suffered from any of the following complaints (Please delete as appropriate)?
Heart complaints
Yes No
Skin Complaints
Yes No
Diabetes
Yes No
Migraines
Yes No
Asthma
Yes No
Allergies
Yes No
Back or Neck Problems
Yes No
Phobias
Yes No
Epilepsy
Yes No
Are you pregnant or breastfeeding?
Yes No
Have you broken any bones or suffered from any serious muscle sprains /strains?
Yes No
Do you have any other major illness or disability which may affect your participation?
Yes No
If you have answered Yes to any of the above, please give details overleaf.
Note:
If the Participant has answered “yes” to any of the questions above, Mud and Sweat reserves the right at any time to prevent the Participant from taking part in the
Event, if in Mud and Sweat’s sole discretion it considers such action necessary for the safety of the Participant. No refund of the entry fee shall be made if the
Participant is deemed to be incapable of safely competing in the Event.
3. I hereby confirm that I am physically capable of competing in the Event. If, at any time hereafter, I develop or discover any medical or physical limitation or condition
(including, but not limited to, those listed in paragraph 2. above) that might affect my ability to safely participate in the Event, or meet the physical demands required
thereof, I agree to make such limitations and conditions immediately known to Mud and Sweat and to cease participating in the Event. Mud and Sweat recommends
that each Participant should seek medical advice as to his/her participation in the Event and I acknowledge that I have read and understood this recommendation.
4. I hereby represent that I am participating in the Event voluntarily, with full knowledge of the potential risks entailed and that I am expressly, knowingly and
voluntarily assuming the risk of any and all physical or emotional injury associated with or caused by my participation in the Event.
5. In view of the foregoing, and as a term and condition of participating in the Event, I hereby release, discharge and hold harmless, for myself and my heirs, executors,
administrators and assigns, Way Ahead (Mud and Sweat), its staff and contractors, participating sponsors, venues and charities, and each of their respective parents,
subsidiaries, affiliates, advertising and promotion agencies and medical advisors, and each of the officers, directors, shareholders, employees, and agents of the
foregoing (collectively, the “Released Parties”), from and in respect of any injury or illness that I may suffer as a result of my participation in the Event.
6. I hereby accept total responsibility for the condition and maintenance of any equipment I bring to the Event I hereby release, discharge and hold harmless, for myself
and my heirs, executors, administrators and assigns, Way Ahead (Mud and Sweat) and the Released Parties, from and in respect of any loss of or damage to any
equipment which occurs travelling to and from and during the Event.
7. I hereby acknowledge that information collated on the Entry Form and Registration Forms submitted by me may be shared with other organisers of the Event.
The information you provide on this form will be held in accordance with the Data Protection Act 1998.
8. Please tick this box if you DO NOT wish to receive information about future events organised and/or promoted by Mud and Sweat. 
I hereby:
8.1 Irrevocably consent to my appearance in the Event being filmed, recorded, incorporated, edited, used disseminated, adapted, modified, copied and exploited in
whole or in part in any television programme, film, video or broadcast of whatever nature by all means and in all media and formats now known or subsequently
invented after the date shown below; and
8.2 Irrevocably consent to the use and reproduction by Mud and Sweat and its designees of my name, likeness, appearance in photographs, films and recordings by all
means and in all media throughout the world in perpetuity and for no additional compensation (unless prohibited by law) for the purpose of advertising, publicity and
otherwise in relation to the exploitation of the Event and/or the promotion of the Event and the exploitation of the commercial rights relating to the Event provided
that such use does not imply my direct endorsement of any third party including any official sponsor or supplier of the Event; and
8.3 Warrant that I am at least 18 years of age and have the full right and power to enter into this Medical Waiver and Consent Form and that the terms of this
document do not in any way conflict with any existing commitment on my part (Participants aged 16 and 17, must have their form countersigned by a parent or
guardian).
9. I hereby acknowledge and agree:
9.1 that the total liability of Way Ahead (Mud and Sweat) in respect of any loss or damage suffered by me and arising out of or in connection with the Conditions of
Entry or my participation in the Event shall not exceed the amount of the fees actually paid by me to Way Ahead pursuant to the Conditions of Entry.
9.2 Mud and Sweat shall not be liable for:
9.2.1 Any loss or damage of personal equipment belonging to me; or
9.2.2 any indirect or consequential losses suffered or incurred by me arising out of me taking part in the Event or any other matter arising under these Conditions of
Entry in any case whether or not such losses or damage were within the contemplation of the parties when I submitted the Entry Form.
10. Nothing in this Participant's Medical Waiver and Consent Form shall exclude or limit the liability of Mud and Sweat for death or personal injury caused by Mud and
Sweat’s negligence, for fraud or fraudulent misrepresentation, or for any matter for which it would be illegal for Mud and Sweat to exclude or attempt to exclude its
liability.
11. I agree that this Medical Waiver and Consent Form supersedes any prior understanding between myself and Mud and Sweat relating to the rights granted herein and
no provisions of this Medical Waiver and Consent Form can be modified by any other instrument, invoice or document unless in writing and signed by the parties hereto.
12. My signature on the entry form confirms that I have read, understood and agree to the contents of this Participant’s Medical Waiver and Consent Form.
www.mudandsweat.com