July 17, 2010 to July 18, 2010 - Canada
July 17 & 18, 2010 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 if registered and paid prior to June 21, 2010:
ATHLETE (One Event - circle Fence, Swim, Combined) ENTRY FEE $110.00
ATHLETE (Two Events - circle Fence, Swim, Combined) ENTRY FEE $135.00
ATHLETE (NON RIDER) ENTRY FEE: $150.00
ATHLETE (RIDER) (Includes Senior, Junior, & Masters) ENTRY FEE: $200.00
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 >30 years, Women>30 years)
PARA-OLYMPIC (with documented disability) Athletes may compete in all categories to which they are eligible but must declare a category for medal contention. Medal Class: ________________
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 or alternate. If horses become unavailable, due to unforeseen circumstances, Masters will not ride, and be reimbursed the riding fee or will ride a lower height for a reduced score..
Meals Included: July 17: Breakfast & Lunch
Meals Included : July 18: Breakfast, Lunch and Banquet
Tee Shirt Included: Please Indicate Size: S M L X/L
Supporter (Parent, Coach) FEE: $ 85.00 (July 17 - Breakfast and Lunch/ July 18 - Breakfast, Lunch & Banquet)
Additional Tee Shirt: FEE: $ 25.00 Please Indicate Size S M L X/L
Please Make Cheques Payable To: Alberta Modern Pentathlon Association
EARLY REGISTRATION: A deduction of $25.00 will be made on all registrations paid by 01 June.
LATE FEE: Additional $150.00 after June 21. No registrations will be accepted after July 05.
Send Registration Form, Waivers and Cheque (payable to: AMPA) to:
Russell Caine, 3 Ashley Close, Red Deer, Alberta T4R 2X3 PHONE: 403-755-2731 EMAIL: rhcaine@shaw.ca
Transportation: There will be a bus pick up from Edmonton (YEG) or Calgary (YYC) International Airports on July 16, Friday morning at 12:00. Transportation will also be available on Friday through Sunday for the competition, technical meeting and dinner. Transportation will be available all day to all venues during the competition. Transportation back to Edmonton or Calgary International Airports will be available on Monday morning the July 19, Monday leaving the hotel at 07:00. There is no cost to participants, however only the dates and times listed will be provided.
YEG/YYC arrival flight date and time:________________ YEG/YYC departure date and time___________ __
Tentative Schedule
Friday, 16 July, 2010 - Arrival
Arrival of Athletes, Coaches, Supporters
1400 - 1600 Registration
1600 - 1800 Jury Ride
1900 - 2000 Technical Meeting - Capri Convention Centre - Marseille Room
2000 - 2200 Equipment Check - pistol, riding helmet and fencing gear
Saturday, 17 July 2010 - Individual Event
08:00 - 11:00 Fencing - Red Deer Fencing Club - Grandview Elementary School
11:30 - 12:30 Swimming - Red Deer Recreation Center - 50m outdoor pool
14:00 - 16:30 Riding Event - Willowdale Equestrian Centre - RR4, Red Deer
17:00 - 19:00 Combined Event - Red Deer Biathlon Track - Riverbend Golf Course
Sunday, 18 July 2010 - Relay Event
08:00 - 11:00 Fencing - Red Deer Fencing Club - Grandview Elementary School
11:30 - 12:30 Swimming - Red Deer Recreational Center - 50m outdoor pool
12:00 - 13:00 Lunch
13:00 - 1500 Combined Event
18:00 - 20:00 Awards Banquet - Capri Convention Centre - Palermo/Savonna Rooms
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. Youth B, C, D and E fencers may wear 350N Jacket, 350N Plastron, 350N Breeches, 800N Helmet and knee socks.
- Spare Body Wire
- Spare Epee
Swimming
- Swimwear in good condition- current FINA rules in effect - single suit
Running
- Shirt or singlet must be worn with athlete's surname and nation code on the back. The run course is grass and gravel track. The use of spikes will be determined after upgrades to the course are completed..
Riding
- Breeches, Jacket & Tie for men, Breeches, Jacket & blouse for women
- Riding boots with heel
- ASTM approved Helmets are mandatory
Accommodation: Accommodations are available either through Red Deer College (www.rdc.ab.ca) or the Capri Convention Centre (www.capricentre.com).
Red Deer College - $40.00 per person per night or $125.00 per night for a complete 4 room group. Rooms must be booked and paid in advance through AMPA.
Capri Centre - $99.00 per night for Standard Room (2 queen beds) or $109.00 for Deluxe Room (1 king bed). Reservations must be made individually through the Capri Centre, 1-800-662-7197.
All reservations must be made on or before 16 June to ensure availability at the discounted rate. Attendees are "on their own' after 16 June 2010 for finding suitable accommodation.
RV: 10 RV sites are available at Willowdale Stables.
Pre-Competition Camp:
The opportunity exists for a pre-competition camp in all disciples. Camp costs will depend upon events and length. Please indicate your preferences for disciplines and length:
I want a pre-Competition Camp: Yes or No 5 Days _____ 2 Days____
Fencing Yes or No
Swimming Yes or No
Combined Event Yes or No
Riding Yes or No
Local Events: Calgary Stampede (the Greatest Show on Earth) July 9 - 18, 2010
cs.calgarystampede.com
Westerner Days (Red Deer, Alberta) July 21 - 25, 2010
www.westernerdays.ca
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 Alberta 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 Alberta Modern Pentathlon Association, its directors, officers, employees, agents and representatives (all of whom are collectively referred to as "CAMPA" and "AMPA");
- TO RELEASE CAMPA/AMPA 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 Alberta;
- 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 Alberta/ 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 Alberta 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 Deer, Alberta on the 17th and 18th of July 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 Willowdale 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 Province of Alberta and no other jurisdiction.
- Any litigation involving the parties to this Agreement shall be brought solely within the Province of Alberta and shall be within the exclusive jurisdiction of the Courts of the Province of Alberta.
- 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 ________________, 2010
__________________________ ___________________________
Witness' Signature Athlete's Signature
__________________________ ___________________________
Witness' Printed Name Athlete's Printed Name
__________________________ ___________________________
Witness' Address Athlete's Address
