Splash New Zealand Freediving Pool Nationals, Auckland, 15-17 September 2017

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About you

Full Name *

Address *

Contact Mobile Phone Number *

We will be sending texts out during the competition

Your Email address *

Date of Birth *

YYYY

Gender *

Male

Female

Current PBs

Please give us your recent PBs and dates achieved (this is to help our Safety Divers)

Representing Club *

Nationality

Please tell us your nationality for competition purposes

Nationality *

Emergency Contact information

Emergency Contact Name *

Contact Phone *

Relationship to you *

Participation Grade and Entry Fees

We offer a "competition grade" which qualify for AIDA rankings and a "recreational grade" for competitors who do not want their participation recorded against world rankings

Payment of competition fees should be made to AIDA New Zealand, Bank Account number 38-9007-0470620-00 with your name and Pool Nats 2017 as the reference for the payment

I want to compete in the *

Competition Grade

Recreation Grade

Required

Fees will be paid via *

Internet Banking

Paypal (pay to admin@aidanz.co.nz)

Agreement

Please remember to bring a completed medical form with you to the competition *

I agree to being filmed/photographed throughout the competition and the footage being retained and used by AIDA or AIDA NZ for promotional or other purposes, I have read the information sheet, I have paid my entry fee and subs to AIDA NZ where required

hereby affirm that I have been thoroughly informed of the risk involved with any freediving / breath-hold activity.

I understand that freediving / breath-holding underwater may involve inherent risks including but not limited to hypoxia, blackout, drowning or hyperbaric accidents. Treatment of a freediving / breath-hold diving accident victim with these or other injuries may require immediate medical attention and / or hyperbaric oxygen therapy.

I specifically understand that the risk of shallow water blackout is inherent of freediving / breath-hold diving activities, and that I still intend to participate in freediving / breath-hold diving. I agree that I will not freedive / breath-hold alone; I will always freedive with a qualified surface support freediver with me at all times.

I understand that neither AIDA New Zealand, nor AIDA International, nor their members, nor any of their respective officers, agents and employees (hereinafter referred to as “Released Parties”) may be held liable or responsible in any way for any injury, death or other damages to myself, my family, heirs or assigns that may occur as a result of my participation in this freediving / breath-hold competition or as a result of the negligence of any party, including the Released Parties, whether passive or active.

I agree to hold harmless the Released Parties from any claim or lawsuit by myself, my family, estate, heirs or assigns, arising during or after I complete the freediving / breath-hold competition.

I understand that any diving activities are physically strenuous and that I will be exerting myself during this freediving / breath-hold diving competition, and I expressly assume the risk of any and all injuries, and I will not hold the Released Parties responsible if I am injured as a result of heart attack, panic, hypoxia, hyperventilation, oxygen toxicity, decompression illness, gas embolism, drowning or any other causes of injury or death not specifically stated herein.

It is my intention by completing this document to exempt and release all of the Released Parties as defined herein, from all liability whatsoever for personal injury, property damage or wrongful death however caused, including but not limited to the negligence of the Released Parties, whether active or passive.

I HAVE FULLY INFORMED MYSELF OF THE CONTENTS OF THIS LIABILITY REALEASE AND ASSUMPTION OF RISK BY READING IT BEFORE SIGNING IT ON BEHALF OF MY HEIRS AND MYSELF.

Required

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