1. Healthcare

NANAIMO’S INAGURAL 1000m LOOP DRAGON BOAT
REGATTA
AQUA DETERMINATION
SUNDAY APRIL 26, 2015
RACE INFORMATION PACKAGE
Contact: 250 – 797 – 5037
Email: [email protected]
PRESENTED BY
Angels & Demons Dragon Boat Club
&
VI PADDLING
Angels & Demons Dragon Boat Club
5137 Carol Place
Nanaimo, BC, V9T 5Z3
FEATURING 10 MAN CHAMPION DRAGON BOATS
2015 AQUA DETERMINATION
RACE INFORMATION PACKAGE
Date: Sunday April 26, 2015
Location: Maffeo Sutton Park, Nanaimo
Race Distance: 1000m Loop
Race Categories: Women & Mixed
Boats: Champion 10 Man from VI Paddling
Maximum Number of Teams Accepted: A maximum of 21 teams will be accepted, 6 Women
and 15 Mixed. Registration is accepted on a First-Come-First-Serve basis and may sell out
before the deadline. We encourage teams to register as soon as possible in order to secure
a spot.
Race Fee & Deadline:
$250.00
Deadline April 12, 2015
Payment Options:
Cash, Money Order and/ or Cheque Payable To:
Angels and Demons Dragon Boat Club
Cancellation/ Refund Policy:
There will be a 10% administration fee for all withdrawals. The final date to
withdraw a team from the Regatta is April 12, 2015. There will be NO
REFUNDS of any kind after the regatta starts, if the Regatta is cancelled due to
weather conditions or other Safety reasons prior to starting full refund.
Registration Instructions: PLEASE READ CAREFULLY
Step 1: Make your payment to reserve your spot in the Regatta and submit your team
information form.
o Mailing Address: Mail team information forms and cheque payment to:
Angels & Demons Dragon Boat Club
5137 Carol Place
Nanaimo, BC, V9T 5Z3
Step 2: Submit your completed team registration by April 12, 2015.
o
o
o
o
Team Information Form – Fill & Print Form
Adult Group Waiver & Roster Forms – Fill, Print & Sign
Junior Group Acknowledge of Risk & Roster Form - *MANDATORY*
(For paddler under 19 years of age) – Fill, Print & Sign
All forms MUST BE mailed or hand delivered. We will not accept faxed copies.
Please ensure all forms are completed and that all fields are typed &/ or signed. Any names or
addresses that cannot be easily read will be discarded and that individual or team will be prevented
from racing. The team manager must provide an email contact.
*Privacy Statement: All personal information given by participants will only be used for
administration and regular communication with respect to the regatta and related programs and
events. Your information will not be sold or given to anyone else with commercial intentions or
otherwise.
Additional Information
Race Format: 1000m Loop, 3 lanes to the 450m marker, then the lead boat has right-of-way.
We recommend that you practice posting (turning) at least 8 practice sessions and a competent
Steersperson in order to safely compete in the regatta.
Women’s Category: Minimum of 6 registered teams required to run category. If, insufficient
registration, women’s crews will race in the Mixed Category.
Mixed Category: There must be a minimum of 5 women paddlers in the boat at all times.
PFD’s & Paddles: There will be NO PFD’s or paddles supplied, all paddlers must have their own.
Race Event Apparel: There will be shirts, Dry-Fits & hoodies available to purchase only on preorder. Apparel from Embroidery Zone & Custom Apparel, Nanaimo. See attached order forms.
Food & Beverage: Tim Horton’s
Race Location: Maffeo Sutton Park, 10 Comox Rd., Nanaimo, V9R 0B3
Team Tents: “Tent City” for paddlers and teams will be located on the grass area to the right of the
Lagoon. All teams are required to leave their spaces in the same condition that they found it in. All
garbage must leave with the team.
ADULT GROUP WAIVER FORM
Release of Liability, Waiver of Claims, Assumption of Risks and Indemnity Agreement (the “Agreement”) BY
SIGNING THIS AGREEMENT YOU WILL GIVE UP CERTAIN LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE
PART ONE: Please Read Carefully and provide all information required for Part One and Part Two of this
Group Waiver Form
Re: Participation in the Aqua Determination event, pursuant to the DBC/ IDBF safety guidelines, rules and
regulations (collectively referred to as the “Rules”).
PLEASE TYPE OR PRINT CLEARLY:
Manager: ______________________________ Team Name: ________________________________
Address: _______________________________ City: ______________________ Prov.: __________
Postal Code: ______________ Phone: __________________ Email: _________________________
To: Angels & Demons Dragon Boat Club and VI Paddling and their respective directors, officers, employees,
contractors, representatives, officials, agents and volunteers.
ASSUMPTION of RISKS
I am aware and understand that the sport of paddling has inherent dangers, hazards and risks. The following
is only a partial list of examples of these RISKS.


Overturning
Equipment Failure


Negligence
Conditions of Water Surface



Poor Swimming
Ability
Site Hazard

Abrupt Weather Changes

Travel To & From
Improper Use of
Equipment
Sustained Rigorous
Physical Activity
Collision with Manmade or
Natural Objects or Other
Paddlers or Bystanders
I understand that injuries from such RISKS are a probable occurrence of the sport of dragon boating. I freely
accept and fully assume all risks and the possibility of personal injury, death, property damage or loss resulting
from participating in the sport of paddling as a participant in this event.


RELEASE of LIABILITY, WAIVER and INDEMNITY
In consideration of my participation in the AQUA DETERNIMATION, I (together with my heirs, next-of-kin,
executors, administrators and assignees, collectively called my “Legal Representatives” agrees as follows. By
signing this waiver the Participant agrees to become an Associate Member of Angels & Demons Dragon Boat
Club. This associate membership is solely for the purpose of covering Accident and Liability Insurance. This
does not entitle the Associate member any voting rights or privileges.
PARTICIPANTS: MUST PRINT & SIGN NAME ON THE CREW ROSTER
1. To waive any and all claims that I have against Angels & Demons & VI Paddling and
2. To release Angels & Demons & VI Paddling from any and all liability for loss, damage, injury or expense
that I may suffer or,
3. To hold harmless and Indemnify the Angels & Demons and VI Paddling from all liability for any damage
or personal injury to any third party resulting from my participation.
By signing this release I am indicating that I have read and understand this document and that I am aware that
by signing this Release I am waiving certain legal rights I may have against the Angels & Demons & VI Paddling.
Or if I die, by signing the Release I am waiving certain legal rights, which my Legal Representatives may have
against the Angels & Demons and VI Paddling.
Team: _____________________ Manager: _________________________ Sign: _________________
ADULT GROUP WAIVER FORM
PART TWO: Team Roster (All Fields Required to be Filled)
TEAM NAME: __________________________________________________________________
By signing below, I confirm that I have read and understood this Agreement prior to signing it, and I
am aware that by signing this Agreement I am waiving certain legal rights which I or my heirs, next-ofkin, executors, administrators and representatives may have against the releases.
#
Coach
Steer
1
2
3
4
5
6
7
8
9
10
11
12
Name (Please Print)
Signature
Email (Please Print)
As team manager I acknowledge that no person is permitted to board the dragon boat unless his or
her name is on this list. I certify that the persons, whose names are listed above, have read and
understand the waiver form.
Manager’s Name: _________________________ Manager’s Signature: ________________________
Email: ____________________________________________ Date: ____________________________
Witness Name: ___________________________ Witness Signature: __________________________
ACKNOWLEDGEMENT of RISKS for JUNIOR PADDLERS (13 – 18 yrs.)
PART ONE – To be signed by each Junior Paddler
By signing this you acknowledge that you are aware of certain risks
PLEASE READ CAREFULLY!
Name of Registrant: ______________________________ Phone: ______________________
Address: _____________________________________________________________________
To: Angels & Demons and VI Paddling
ASSUMPTION of RISKS
I am aware and understand that the sport of paddling has inherent dangers, hazards and
risks. The following is only a partial list of examples of these RISKS.
 Overturning
 Equipment Failure
 Negligence
 Conditions of Water Surface
 Poor Swimming
Ability
 Site Hazard
 Abrupt Weather Changes
 Travel To & From
 Improper Use of
Equipment
 Sustained Rigorous
Physical Activity
 Collision with Manmade or
Natural Objects or Other
Paddlers or Bystanders
I understand that injuries resulting from such Risks are a possible occurrence of the sport of
dragon boat racing.
I acknowledge that it is my responsibility to act in such a manner as to be responsible for my
own safety and participate within my own limits.
Signature of Registrant: ______________________________ Team: ___________________
I, as a parent or guardian of the Registrant, acknowledge that, by my signing this document,
I am, in addition to the Registrant and others, assuming the responsibility to educate and
inform the Registrant of the Risks.
Also in consideration of the Aqua Determination Regatta permitting the Registrant to
participate in the dragon boat races and activities, I agree to save harmless and indemnify
the Angels & Demons and VI Paddling, officers and directors, employees and volunteers and
all regatta sponsors from any claims, actions, damages, expenses, or costs, arising out of:
the participation of the Registrant, the actions of the Registrant, claims made by the
Registrant resulting from the Risks inherent in dragon boat racing, the actions of (including
their negligence) officers, directors, employees, volunteers, regatta sponsors, or the
Registrant’s own negligence.
Signature of Parent/ Guardian: ________________________________ Date: ____________
Witness’ Signature: ________________________________________
JUNIOR GROUP WAIVER FORM
PART TWO: Team Roster (All Fields Required to be Filled)
TEAM NAME: __________________________________________________________________
By signing below, I confirm that I have read and understood this Agreement prior to signing it, and I
am aware that by signing this Agreement I am waiving certain legal rights which I or my heirs, next-ofkin, executors, administrators and representatives may have against the releases.
#
Coach
Steer
1
2
3
4
5
6
7
8
9
10
11
12
Name (Please Print)
Signature
Email (Please Print)
As team manager I acknowledge that no person is permitted to board the dragon boat unless his or
her name is on this list. I certify that the persons, whose names are listed above, have read and
understand the waiver form.
Manager’s Name: _________________________ Manager’s Signature: ________________________
Email: ____________________________________________ Date: ____________________________
Witness Name: ___________________________ Witness Signature: __________________________
AQUA DETERNIMATION
REGATTA APPAREL
PRE-ORDER FORM
PLEASE SPECIFY LADIES OR MENS
SHIRTS – Size XS - XXXL
Dri-Fit
T-Shirt
Longsleeve
SIZE
L/M
QUANITY
COST/ SHIRT
$13.00
$15.00
TOTAL
Cotton
T-Shirt
SIZE
L/M
QUANITY
COST/ SHIRT
$12.00
TOTAL
HOODIES
UNISEX
SIZES – XS – XXXL
STYLE
Pullover
Zipper
SIZE
QUANITY
COST/ SHIRT
$30.00
$35.00
TOTAL
ACKNOWLEDGEMENT of RISKS for VOLUNTEERS
PART ONE – To be signed by each Volunteer
By signing this you acknowledge that you are aware of certain risks
PLEASE READ CAREFULLY!
Name of Volunteer: ______________________________ Phone: ______________________
Address: _____________________________________________________________________
To: Angels & Demons and VI Paddling
ASSUMPTION of RISKS
I am aware and understand that the sport of paddling has inherent dangers, hazards and
risks. The following is only a partial list of examples of these RISKS.
 Overturning
 Equipment Failure
 Negligence
 Conditions of Water Surface
 Poor Swimming
Ability
 Site Hazard
 Abrupt Weather Changes
 Travel To & From
 Improper Use of
Equipment
 Sustained Rigorous
Physical Activity
 Collision with Manmade or
Natural Objects or Other
Paddlers or Bystanders
I understand that injuries resulting from such Risks are a possible occurrence of the sport of
dragon boat racing.
I acknowledge that it is my responsibility to act in such a manner as to be responsible for my
own safety and participate within my own limits.
Signature of Volunteer: ______________________________ Date: _____________________
Youth Volunteer – (13 – 18 yrs.)
I, as a parent or guardian of the Registrant, acknowledge that, by my signing this document,
I am, in addition to the Registrant and others, assuming the responsibility to educate and
inform the Registrant of the Risks.
Also in consideration of the Aqua Determination Regatta permitting the Registrant to
participate in the dragon boat races and activities, I agree to save harmless and indemnify
the Angels & Demons and VI Paddling, officers and directors, employees and volunteers and
all regatta sponsors from any claims, actions, damages, expenses, or costs, arising out of:
the participation of the Registrant, the actions of the Registrant, claims made by the
Registrant resulting from the Risks inherent in dragon boat racing, the actions of (including
their negligence) officers, directors, employees, volunteers, regatta sponsors, or the
Registrant’s own negligence.
Signature of Parent/ Guardian: ________________________________ Date: ____________
Witness’ Signature: ________________________________________ Date: ______________