GPC Mackay Cup Entry Form

Name

Email

Phone Number

Next of Kin

Next of Kin Contact Number

Events Entering

Raw‎ Equipped‎

Gender

Male‎ Female‎

Weight Class M

Weight Class F

Age at time of Comp

Date of Birth

DECLARATION: in consideration of, and as a condition of acceptance of my entry in this event, hereby waive all and any claim, right or cause of action which I or my heirs might otherwise have arising out of loss of my life, or injury, damage or loss of any description whatsoever which I may suffer or sustain in the course of or consequent upon my participation in the said event, including expenses of subsequent medical treatment or hospitalisation.

This waiver, release and discharge shall be and operate separately in favour of all persons, companies and bodies involved in promotion or conduct of the event, and the servants, agents, representatives, and officers of any of them, and of any first aid or paramedical personnel summoned in the event of injury to me.

I do not have a medical condition for which my entry in this event presents a risk to my health and others.

I voluntarily and knowingly accept the risk of injury by my participation in this event entails. I certify that I am 18 years of age or older, or that I am the parent/guardian of the participant competing and that I have read this document and fully understand it. SIGNATURE:

Clear