New Zealand Road events entry form and release

Please Use the print the page link to print entry form and release (3 pages) Click>>print this page            
Please use Block letters.
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Telephone:|__|__|__|__|__|__|__|__|__|__|__|__|

Email:|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|
Age:|__|__|
Gender: Male:|__| Female:|__|

Who to notify in case of emergency__________________________
Telephone:_________________________

Rider Categories:
Elite: 19+ years
Senior/Open: 19 - 34 years
Juniors: 18 years and Under 
Masters: 35 - 44 years
Veterans: 45 - 54 years
Super Vets: 55 - 64 years
Grand Masters: 65+
Teams: Mens/Womens/Mixed (2/3/4 person any age/combination)

Age restrictions:
100k open to 16 years +
70k open to 15 years +

Entry Fees:
100k Solo $75
100k Teams (2/3/4 person: $65 each) $130, $195, $260 

70k Solo $55
70k Teams (2/3/4 person: $45 each) $90, $135, $180 

25k Solo $35


Pre-Entries close Nov 11th
Late fee/s $15 per entry

Total/s: $|__|__|__|

Please make cheques payable to:
DCP,
P.O Box 101-394 NSMC, Auckland.

Depeche Cycling Promotions reserves the right to refuse entrys to any of our events from anyone for any reason.

TO THE ORGANIZER: Depeche Cycling Promotions:

In consideration of the Releasees or the acceptance of my application for entry in the above event, I hereby freely agree to and make the following contractual representations and agreements.

I acknowledge that cycling is an inherently dangerous sport and fully realize the dangers of participating in a bicycle ride/race and FULLY ASSUME THE RISKS ASSOCIATED WITH SUCH PARTICIPATION INCLUDING, by way of example, and not limitation, the following: the dangers of collision with pedestrians, vehicles, other riders/racers, and fixed or moving objects; the dangers arising from surface hazards, equipment failure, inadequate safety equipment, THE RELEASEES' OWN NEGLIGENCE, and weather conditions; and the possibility of serious physical and/or mental trauma or injury associated with athletic cycling competition.

For myself, my heirs, executors, administrators, legal representatives, assignees, and successors in interest (collectively "Successors") I HEREBY WAIVE, RELEASE, DISCHARGE, HOLD HARMLESS, AND PROMISE TO INDEMNIFY AND NOT TO SUE the Releasees and the sponsors of this event, the organizer and any promoting organizations, property owners, law enforcement agencies, all public entities, special districts and properties, and their respective agents, officials, and employees through or by which the events will be held, (the foregoing are also collectively deemed to be Releasees), FROM ANY and all rights and CLAIMS INCLUDING CLAIMS ARISING FROM THE RELEASEES' OWN NEGLIGENCE, which I have or which may hereafter accrue to me and from any and all damages which may be sustained by me directly or indirectly in connection with, or arising out of, my participation in or association with the event, or travel to or return from the event.

I agree it is my sole responsibility to be familiar with the Event ride/race course, the Releasee's rules, and any special regulations for the event. I understand and agree that situations may arise during the ride/race which may be beyond the immediate control of the race officials or organizers, and I must continually ride so as to neither endanger myself nor others. I accept responsibility for the condition and adequacy of my competition equipment. I will compete wearing a helmet which satisfies the requirements of the Releasees Ride/Racing Rules or Regulations and that can protect against serious head injury, and assume all responsibility and liability for the selection of such a helmet. I have no physical or medical condition which to my knowledge, would endanger myself or others if I participate in this event, or would interfere with my ability to participate in this event.

I agree, for myself and my successors, that the above representations are contractually binding, and are not mere recitals, and that should I or my successors assert my claim in contravention of this agreement, the asserting party shall be liable for the expenses (including legal fees) incurred by the other party or parties in defending, unless the other party or parties are finally adjudged liable on such claim for willful and wanton negligence. This agreement may not be modified orally, and a waiver of any provision shall not be construed as a modification of any other provision herein or as a consent to any subsequent waiver or modification. Every term and provision of this agreement is intended to be severable. If any one or more of them is found to be unenforceable or invalid, that shall not affect the other terms and provisions, which shall remain binding and enforceable.

I hereby agree that by signing this on behalf of myself and my Team, I and my Team riders are responsible for my/their own personal accident and ambulance cover and expenses.

By signing this entry form and release my personal details will be added to the Depeche Cycling Promotions Summer of cycling email and postal mailing list.

I AGREE TO OBEY AND FOLLOW THE NEW ZEALAND ROAD CODE AND EVENT RULES OR FACE IMMEDIATE DISQUALIFACTION.

Signature of entrant

I am the parent or guardian of _________________

(Child). My Child is fit for the ride/race, and I consent to my Child's participation. I HAVE READ AND I UNDERSTAND THE ENTRY FORM AND RELEASE AGREEMENT. In consideration of allowing my Child to participate, I consent to it and agree that ITS TERMS SHALL LIKEWISE BIND ME, MY CHILD, my heirs, legal representatives, and assignees. I HEREBY RELEASE AND SHALL DEFEND, INDEMNIFY AND HOLD HARMLESS THE RELEASEES FROM EVERY CLAIM AND ANY LIABILITY that I or my Child may allege against the Releasees (including reasonable attorney's fees or costs) as a direct or indirect result of injury to me or my Child because of my Child's participation in the event, WHETHER CAUSED BY THE NEGLIGENCE OF THE RELEASEES or others. I PROMISE NOT TO SUE RELEASEES on my behalf or on behalf of my Child regarding any claim arising from my Child's participation in the ride/race.

Signature of parent or guardian