9OC Entry Form and Waiver .pdf

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Original filename: 9OC Entry Form and Waiver.pdf
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ENTRY FORM
CATEGORIES AND REGISTRATION FEES
COMPETITIVE (PHP 1,000)

FUN (PHP 2,500)

☐ 6K MALE
☐ 6K FEMALE
☐ 2K MALE
☐ 2K FEMALE

☐ 6K MIXED
☐ 2K MIXED

SWIMMER PROFILE
FAMILY NAME

GIVEN NAME

DATE OF BIRTH (MM/DD/YYYY)

AGE

SEX (M/F)

M.I.

NATIONALITY

ADDRESS

MOBILE

TELEPHONE



EMAIL

I want my finisher certificate mailed to the indicated address above. (Fee: PHP 150.00)

TEAM PROFILE (Optional)
NAME OF TEAM

NAME OF COACH




MOBILE

EMAIL

I have read and accepted the race and resort rules and regulations.
I attest that all the information provided in the entry form are true and correct.

SIGNATURE OVER PRINTED NAME

LIST OF COMPANIONS
1.
2.
3.
4.

TO BE FILLED UP BY PBSP/PSI
SUPPORTING DOCUMENTS
☐ WAIVER
☐ MEDICAL CERTIFICATE
☐ PAYMENT / DEPOSIT SLIP
RECEIVED BY: ______________________________
DATE RECEIVED: ___________________________
OFFICIAL RECEIPT NO. _____________________

WAIVER
I understand the purpose of this waiver is to preclude others and myself from bringing any claim or legal
action arising out of my participation in the OLANGO CHALLENGE. The OLANGO CHALLENGE is an
open-water swimming event in the waters along Pacific Cebu Resort.
In consideration of the acceptance of my entry in this open water swim, I, for myself, my heirs, executors
and administrators, hereby unconditionally release and forever discharge Philippine Business for Social
Progress, its officers, staff, and the members thereof, the Philippine Swimming Inc. and members thereof,
the OLANGO CHALLENGE Organizing Committee, all sponsors, race directors, lifeguards, volunteers and
producers of these events, and their respective heirs, executors, administrators, successors and assigns,
from any and all liabilities, actions, claims, demands, damages, costs and expenses, which I may now or in
the future have against them, or any of them, in any way arising out of or in any way connected to my
participation in, or the operation of, the OLANGO CHALLENGE event and any practice or training
session associated therewith or other functions or events, including but not limited to any claims that are
based on any alleged negligence or other action or inaction of any of the above mentioned parties.
I am aware of the hazards inherent in open water swimming, including the potential for hypothermia,
cardiovascular problems, drowning, permanent disability or other injury and that in entering this or any
other open water event I am doing so at my own risk. To the best of my knowledge, my physical
condition and fitness are adequate for me to participate in the OLANGO CHALLENGE for which I have
submitted an entry, which includes a Medical Certificate attesting to my physical fitness for the purpose,
and I am unaware of any reason, physical or otherwise, why I should not participate. I agree to comply
with all rules, regulations and event instructions, and I consent to receive any and all medical treatment
which organizers of the OLANGO CHALLENGE consider advisable in the event of illness or injuries
suffered by me during the Swim Event.
I acknowledge that I have read and understood the terms of this release and waiver.

__________________________
Signature of Swimmer

__________________________
Signature of Parent/Guardian
(If swimmer is under 18)

__________________________
Name of Swimmer

__________________________
Name of Parent/Guardian

__________________________
Name of Adult Accompanying
Swimmer on Race Day
(If Swimmer is under 18 years old)
________________________
Mobile Number of Accompanying Adult


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