XBR Summer Series Full Series Entry Form

Date of Birth:

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Indemnity Declaration

BMXNSW INDEMNITY DECLARATION

I, the person submitting this entry form, acknowledge and agree that:

WARNING

BMX racing is inherently dangerous and that serious accidents can and often do happen which may result in me being injured. I declare that I have voluntarily read and understood this Warning and accept and assume the inherent risk or danger in BMX Racing. I declare that I have also read and understood the rules of BMX Australia Inc and agree to be bound by those rules.

EXCLUSION OF LIABILITY

Except to the extent that the Trade Practices Act 1974(Cth) or other legislation applies, and cannot by contract be excluded, I agree that it is a term of entry to the BMXNSW BMXtreme Carnival that BMXNSW Inc, any other of BMXNSW affiliated organisations or bodies and their respective directors, officers, servants or agents (collectively BMXNSW) are absolved from all liability however arising from injury or damage however caused (whether fatal or otherwise) arising out of my participation in this event or in any way due to any negligent act, breach of duty, default and/or omission on the part of BMXNSW.

RELEASE AND INDEMNITY

In consideration of the organisers of this event and BMXNSW Inc allowing me to enter this event I release and forever discharge BMXNSW Inc from all actions, suits, proceedings, claims, demands, damages, penalties, costs and expenses however arising that I may have or may have had but for this release arising from or in conjunction with our participation in this event; and I indemnify BMXNSW to the extent permitted under the Trade Practices Act 1974(Cth) or otherwise by law in respect of any actions, suits, proceedings, claims, demands, losses, damages, costs, expenses, penalties and fines arising as a result of or in conjunction with the event and my participation in the event whether caused or contributed to, directly or indirectly, by any act or omission (including negligence) on the part of BMXNSW. I understand and agree that photographs will be taken during the event and may be published for promotional purposes.

MEDICAL DISCLOSURE

By accepting the terms of this declaration I warrant and covenant that I:

1. am medically fit to compete in the event; and
2. have completed the medical profile annexed to this declaration and that the information contained in that profile is true and correct.

I acknowledge and agree that BMXNSW may direct me not to participate in the event if, based on medical opinion, my participation would constitute an unacceptable risk of:

1. causing me harm, injury or death;
2. aggravating an existing injury or illness I may have; or
3. infecting or injuring officials or other competitors.

I have read, understood, acknowledge and agree to the above Warning, Exclusion of Liability, Release and Indemnity and Medical Disclosure. Further, I agree to submit the Indemnity Declaration and Medical Profile Form (pdf) for each rider I enter in the event(s) and assume with full knowledge the danger inherent in BMX Racing and the event.

(Note: To enter this event, you must select "Yes" in the Indemnity Declaration acceptance field below. A signed copy of the BMXNSW Indemnity Declaration and Medical Profile Form must be submitted at registration. In the case of competitors/entrants under the age of 18 years, the Form must be acknowledged and signed by the competitor/entrant and his/her legal parent/guardian. Copies of the Form will be available at registration.)

We have 2 payment options available, PayPal, which includes Credit Card (MC or Visa only), and Cheque/MO.

For your own records, please print this completed form before submitting your entry. You should receive confirmation of entry and payment within 7 days (if using PayPal/Credit Card or Cheque/MO). If not, please contact us (Ph: 0412 246 012, email: editor@xbr.com.au) rather than re-submitting.