Wow Reg Form
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WONDERS OF THE WEST (W.O.W) ADVENTURE RACE 2009 REGISTRATION FORM ABOUT THE RACE The Wonder Of the West Race (W.O.W Race) is organised by the West Coast Youth Executive Committee with the objective of introducing families and youths to different adventure and sports facilities available in the WEST side of Singapore. Through participation and involvement in outdoor sports and adventure, it also promotes the importance of maintaining healthy lifestyle among Singaporeans. It is a platform for families and youths of different races to interact with one another, using their wits and strategic planning skills to get through the various checkpoints. Participants will be put to the test of their endurance, creativity and teamwork through the many challenges and obstacles. Join us in this race against time, visiting the interesting and fun-filled parts of Western Singapore! Strategise to the finishing point with your wits and be amazed by what you can achieve! RULES AND REGULATIONS 1. Please note that closing date for registration is 31st January 2009, 9pm. 2. Participants who are below 21 years old need to seek parental or guardian’s consent prior to signing up. 3. Entry forms that are not officially endorsed will not be acceptable. Incomplete entry forms will be rejected. No refund will be made for incorrect entries, multiple entries, late entries and participants who wish to withdraw from the competition. 4. The Organiser reserves the right to amend any rules and regulations without prior notice. 5. Once the entry form has been duly processed, there shall be no fee refund for those participants who eventually do not take part for whatever reasons. 6. The Organiser’s decision shall be final. 7. Should inclement weather persist after any initial delays, the Organiser reserves the right to cancel the event without any refund. 8. The Organisers, Sponsors and Partners will not be held responsible for any damage or loss of valuables, injury or death in the course of partaking in the event. 9. Participants can submit their registration in person in West Coast Community Centre: Address: 2 Clementi West Street 2, Singapore 129605 RACE INFORMATION 1. The race will be held on 28th February 2009 (Sat) from 8am to 6.00pm. 2. There are three categories to the race: (a) Competitive (8am-4.00pm): Adults aged 18 to 35 years old (b) Leisure (12pm-3.00pm): 2 Adults aged 21 and above with 2 Children aged below 12 (c) School (10am-3.30pm): Students aged 13 to 17 years old Each group should be made up of at least 4 team members with 1 reserve member. 3. The reserve member can replace the team member ONLY at registration of the race. 4. Team with less than 4 team members at any point of the race will be disqualified immediately. 5. Bonus points of 100 points will be awarded to team who has at least one member of the opposite gender in the main team. 6. Participants will go through and complete a series of adventure/sports related disciplines within a limited time frame. Each group will be given a “passport” that contains details of their route of advancement and will be accredited points at each station by the respective station masters. Team with the highest points wins the race! 7. A representative from the team is required to attend a joint briefing on 15th February 2009. 8. Each team is allowed to carry up to SGD$30. All other communicating device or valuables will be sealed in an envelope during the course of race. The only mode of transport allowed is by foot. 9. Goodie Bag and event T-shirt will be provided for the race during the briefing. 10. The event T-shirt must be worn by all participants throughout the race. 11. Participants are encouraged to go for a medical checkup before the race
Organized by West Coast CC Youth Executive Committee (YEC), Hwa Chong Institution and West Coast Eagle Scout Group
WONDERS OF THE WEST (W.O.W) ADVENTURE RACE 2009 REGISTRATION FORM
Team Information – Pre Requisition for Adventure Disciplines (The race is not restricted to the events listed below. The list serves as a general guide to the events of the race ONLY.) Discipline - Platform Abseiling Participants must have some experience of abseiling and be able to wear harness independently. Safety harness, fingered gloves, climbing/biking helmets will be provided by Race Organizers. Usage of personal equipment for discipline must be approved by Race Organizers prior start of Race during the Briefing. Discipline - Urban Navigation Participants must have sufficient knowledge on reading and using a base plate compass. Base plate compass will be provided by Race Organizers. Other electronic devices like GPS are not allowed. Discipline - Team Challenge Obstacles These are adhoc problem-solving activities at various stations along the course of the race. Discipline – Running (On-Going) Participants must be physical fit for long distance traveling on foot with haversack. The distance to be traveled is estimated to be 15 to 25KM. No other form of transport must be used. Discipline – Lap Swimming (Dependable on Category) Participants must be able to swim. Each team member must be dressed approximately to swim. Discipline - Kayaking (Dependable on Category) Participants must be able to swim. Each team member must wear a life vest, and ensure that the vest is appropriately secured to the body. Life vest will be issued to teams at transition station. Proper footwear covered shoes, booties must be worn during the activity. IMPORTANT: All participants are responsible to read the above information and be aware of the physical demands of the race. The organizer will not be held accountable for any disadvantage resulted from disparity in skill level among participants. Only two members from the team are required to participate in the following disciplines: Platform Abseiling, Lap Swimming and Kayaking.
Organized by West Coast CC Youth Executive Committee (YEC), Hwa Chong Institution and West Coast Eagle Scout Group
WONDERS OF THE WEST (W.O.W) ADVENTURE RACE 2009 REGISTRATION FORM REGISTRATION FORM MEMBER 1: TEAM LEADER
MEMBER 4:
NAME: ................................................................................................ AGE: ...................... GENDER: M / F TEL: ......................................................................NRIC NO: ......................................DOB: ................................ EMAIL:.......................................................................................................... . ADDRESS:................................................................................................... ........................................................ POSTAL CODE .......................... .................................................................................................................... SCH/ORG:.................................................................................................... .
NAME: ................................................................................................ AGE: ...................... GENDER: M / F TEL: ......................................................................NRIC NO: ......................................DOB: ................................ EMAIL:........................................................................................................... ADDRESS:........................................................................................................... ................................................ POSTAL CODE .......................... .................................................................................................................... SCH/ORG:.....................................................................................................
MEMBER 2:
NAME: ................................................................................................ AGE: ...................... GENDER: M / F TEL: ......................................................................NRIC NO: ......................................DOB: ................................ EMAIL:........................................................................................................... ADDRESS:........................................................................................................... ................................................ POSTAL CODE .......................... .................................................................................................................... SCH/ORG:.....................................................................................................
NAME: ................................................................................................ AGE: ...................... GENDER: M / F TEL: ......................................................................NRIC NO: ......................................DOB: ................................ EMAIL:.......................................................................................................... . ADDRESS:................................................................................................... ........................................................ POSTAL CODE .......................... .................................................................................................................... SCH/ORG:.................................................................................................... . REGISTRATION FORM MEMBER 3: NAME: ................................................................................................ AGE: ...................... GENDER: M / F TEL: ......................................................................NRIC NO: ......................................DOB: ................................ EMAIL:.......................................................................................................... . ADDRESS:................................................................................................... ........................................................ POSTAL CODE .......................... SCH/ORG:.................................................................................................... .
MEMBER 5: (RESERVE)
DECLARATION AND WAIVER 1. We declare that all the particulars given are correct and hereby agree to abide by the rules of the W.O.W Race 2009. 2. We hereby confirm our agreement to assume the entire risk of any damages or loss of valuables, injury or death that we may sustain or cause as a result of our participation in the W.O.W Race 2009. 3. We hereby certify that we have read and understood this waiver. We hereby certify that we are physically and medically fit to take part in this event. For and on behalf of the Team Name, NRIC No.& signature of team leader
______________________________ Date: ______________________________
Organized by West Coast CC Youth Executive Committee (YEC), Hwa Chong Institution and West Coast Eagle Scout Group
WONDERS OF THE WEST (W.O.W) ADVENTURE RACE 2009 REGISTRATION FORM INDEMNITY FORM <>
I, _________________________________________ (Name) of ______________ (NRIC / Passport No.), hereby declare that I am participating in the < W.O.W Race 2009 > on <28 FEBRUARY 2009>, on my own free will and volition. I am aware of the possible risks involved and in consideration of being permitted by the <West Coast YEC> and the People’s Association Youth Movement (PAYM) to participate in the Race and hereby for myself, my successors, personal representatives and assigns:
(a) do hereby absolve, acquit and discharge the PAYM and its officers, servants, employees, agents or volunteers from all or any responsibility, actions, causes of action, claims, demands and obligations whatsoever arising from any loss or damage (including, without limitation, physical injury, loss of life or property damage) caused by or sustained as a result of my participation in the Race; and (b) will NOT hold the PAYM and its officers, servants, employees, agents or volunteers against all losses, claims, demands, actions, proceedings, damages, costs or expenses, including legal fees, and any other liability arising in any way from my participation in the Race.
_______________________________
_______________________________
Participant’s Name
Participant’s Signature & Date
In case of emergency, please contact Name of Parent / Guardian (*Dr/Mr/Mrs/Mdm/Ms): Relationship to Participant: Home No.: Office No.: Mobile No.: Email Address:
Organized by West Coast CC Youth Executive Committee (YEC), Hwa Chong Institution and West Coast Eagle Scout Group
WONDERS OF THE WEST (W.O.W) ADVENTURE RACE 2009 REGISTRATION FORM INDEMNITY FORM <>
I, _________________________________________ (Name) of ______________ (NRIC / Passport No.), *parent/guardian of ______________________________________ (Name of Participant) of ______________ (NRIC / Passport No.), hereby acknowledge that I consent to my *child/ward participation in the < W.O.W Race 2009 > on <28th February 2009>. I am aware of the possible risks involved and in consideration of my *child/ward being permitted by the <West Coast YEC> and the People’s Association Youth Movement (PAYM) to participate in the Race, I (a) do hereby absolve, acquit and discharge the PAYM and its officers, servants, employees, agents or volunteers from all or any responsibility, actions, causes of action, claims, demands and obligations whatsoever arising from any loss or damage (including, without limitation, physical injury, loss of life or property damage) caused by or sustained as a result of my *child’s/ward’s participation in the Race; and (b) will NOT hold the PAYM and its officers, servants, employees, agents or volunteers against all losses, claims, demands, actions, proceedings, damages, costs or expenses, including legal fees, and any other liability arising in any way from my *child’s/ward’s participation in the Race. _______________________________
_______________________________
Name of *Parent/Guardian
*Parent’s/ Guardian’s Signature & Date
In case of emergency, please contact Name of Parent / Guardian (*Dr/Mr/Mrs/Mdm/Ms): Relationship to Participant: Home No.: Office No.: Mobile No.: Email Address:
Organized by West Coast CC Youth Executive Committee (YEC), Hwa Chong Institution and West Coast Eagle Scout Group
WONDERS OF THE WEST (W.O.W) ADVENTURE RACE 2009 REGISTRATION FORM MEDICAL DECLARATION Please tick ( ) where applicable.
HAVE YOU EVER HAD
No
Yes
If YES, please provide brief description such as when, diagnosis, treatment, medication was received and whether the condition is stable.
a) High Blood Pressure b) Diabetes c) Asthma d) Tuberculosis e) Heart Disease f) Bone or Joint Injury g) Skin Diseases h) Physical Disabilities i) Hearing Problem j) Eye Problem (excluding short-sightedness) k) Neurological problems (example fits, stroke) l) Nervous problem (e.g. anxiety, schizophrenia) m) Operations or admission to hospital n) Allergy to medicine/food o) Other Medical Problems/Conditions (include pregnancy) SELF-DECLARATION I declare that all the information given above is true and correct.
________________________________
____________________________
Participant’s name
Participant’s Signature and Date
Organized by West Coast CC Youth Executive Committee (YEC), Hwa Chong Institution and West Coast Eagle Scout Group
WONDERS OF THE WEST (W.O.W) ADVENTURE RACE 2009 REGISTRATION FORM (Optional) CERTIFICATION BY CLINIC / MEDICAL EXAMINER (APPLICABLE FOR ‘YES’ DECLARATIONS) I have examined ______________________ (name) on ____________ (date) and found him/her *FIT / UNFIT to participate in the Race above.
Remarks, if any: ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________
_______________________
___________________
____________
Name of medical examiner
Signature and date
Clinic stamp
Organized by West Coast CC Youth Executive Committee (YEC), Hwa Chong Institution and West Coast Eagle Scout Group
Organized by West Coast CC Youth Executive Committee (YEC), Hwa Chong Institution and West Coast Eagle Scout Group
WONDERS OF THE WEST (W.O.W) ADVENTURE RACE 2009 REGISTRATION FORM
Team Information – Pre Requisition for Adventure Disciplines (The race is not restricted to the events listed below. The list serves as a general guide to the events of the race ONLY.) Discipline - Platform Abseiling Participants must have some experience of abseiling and be able to wear harness independently. Safety harness, fingered gloves, climbing/biking helmets will be provided by Race Organizers. Usage of personal equipment for discipline must be approved by Race Organizers prior start of Race during the Briefing. Discipline - Urban Navigation Participants must have sufficient knowledge on reading and using a base plate compass. Base plate compass will be provided by Race Organizers. Other electronic devices like GPS are not allowed. Discipline - Team Challenge Obstacles These are adhoc problem-solving activities at various stations along the course of the race. Discipline – Running (On-Going) Participants must be physical fit for long distance traveling on foot with haversack. The distance to be traveled is estimated to be 15 to 25KM. No other form of transport must be used. Discipline – Lap Swimming (Dependable on Category) Participants must be able to swim. Each team member must be dressed approximately to swim. Discipline - Kayaking (Dependable on Category) Participants must be able to swim. Each team member must wear a life vest, and ensure that the vest is appropriately secured to the body. Life vest will be issued to teams at transition station. Proper footwear covered shoes, booties must be worn during the activity. IMPORTANT: All participants are responsible to read the above information and be aware of the physical demands of the race. The organizer will not be held accountable for any disadvantage resulted from disparity in skill level among participants. Only two members from the team are required to participate in the following disciplines: Platform Abseiling, Lap Swimming and Kayaking.
Organized by West Coast CC Youth Executive Committee (YEC), Hwa Chong Institution and West Coast Eagle Scout Group
WONDERS OF THE WEST (W.O.W) ADVENTURE RACE 2009 REGISTRATION FORM REGISTRATION FORM MEMBER 1: TEAM LEADER
MEMBER 4:
NAME: ................................................................................................ AGE: ...................... GENDER: M / F TEL: ......................................................................NRIC NO: ......................................DOB: ................................ EMAIL:.......................................................................................................... . ADDRESS:................................................................................................... ........................................................ POSTAL CODE .......................... .................................................................................................................... SCH/ORG:.................................................................................................... .
NAME: ................................................................................................ AGE: ...................... GENDER: M / F TEL: ......................................................................NRIC NO: ......................................DOB: ................................ EMAIL:........................................................................................................... ADDRESS:........................................................................................................... ................................................ POSTAL CODE .......................... .................................................................................................................... SCH/ORG:.....................................................................................................
MEMBER 2:
NAME: ................................................................................................ AGE: ...................... GENDER: M / F TEL: ......................................................................NRIC NO: ......................................DOB: ................................ EMAIL:........................................................................................................... ADDRESS:........................................................................................................... ................................................ POSTAL CODE .......................... .................................................................................................................... SCH/ORG:.....................................................................................................
NAME: ................................................................................................ AGE: ...................... GENDER: M / F TEL: ......................................................................NRIC NO: ......................................DOB: ................................ EMAIL:.......................................................................................................... . ADDRESS:................................................................................................... ........................................................ POSTAL CODE .......................... .................................................................................................................... SCH/ORG:.................................................................................................... . REGISTRATION FORM MEMBER 3: NAME: ................................................................................................ AGE: ...................... GENDER: M / F TEL: ......................................................................NRIC NO: ......................................DOB: ................................ EMAIL:.......................................................................................................... . ADDRESS:................................................................................................... ........................................................ POSTAL CODE .......................... SCH/ORG:.................................................................................................... .
MEMBER 5: (RESERVE)
DECLARATION AND WAIVER 1. We declare that all the particulars given are correct and hereby agree to abide by the rules of the W.O.W Race 2009. 2. We hereby confirm our agreement to assume the entire risk of any damages or loss of valuables, injury or death that we may sustain or cause as a result of our participation in the W.O.W Race 2009. 3. We hereby certify that we have read and understood this waiver. We hereby certify that we are physically and medically fit to take part in this event. For and on behalf of the Team Name, NRIC No.& signature of team leader
______________________________ Date: ______________________________
Organized by West Coast CC Youth Executive Committee (YEC), Hwa Chong Institution and West Coast Eagle Scout Group
WONDERS OF THE WEST (W.O.W) ADVENTURE RACE 2009 REGISTRATION FORM INDEMNITY FORM <
I, _________________________________________ (Name) of ______________ (NRIC / Passport No.), hereby declare that I am participating in the < W.O.W Race 2009 > on <28 FEBRUARY 2009>, on my own free will and volition. I am aware of the possible risks involved and in consideration of being permitted by the <West Coast YEC> and the People’s Association Youth Movement (PAYM) to participate in the Race and hereby for myself, my successors, personal representatives and assigns:
(a) do hereby absolve, acquit and discharge the PAYM and its officers, servants, employees, agents or volunteers from all or any responsibility, actions, causes of action, claims, demands and obligations whatsoever arising from any loss or damage (including, without limitation, physical injury, loss of life or property damage) caused by or sustained as a result of my participation in the Race; and (b) will NOT hold the PAYM and its officers, servants, employees, agents or volunteers against all losses, claims, demands, actions, proceedings, damages, costs or expenses, including legal fees, and any other liability arising in any way from my participation in the Race.
_______________________________
_______________________________
Participant’s Name
Participant’s Signature & Date
In case of emergency, please contact Name of Parent / Guardian (*Dr/Mr/Mrs/Mdm/Ms): Relationship to Participant: Home No.: Office No.: Mobile No.: Email Address:
Organized by West Coast CC Youth Executive Committee (YEC), Hwa Chong Institution and West Coast Eagle Scout Group
WONDERS OF THE WEST (W.O.W) ADVENTURE RACE 2009 REGISTRATION FORM INDEMNITY FORM <
I, _________________________________________ (Name) of ______________ (NRIC / Passport No.), *parent/guardian of ______________________________________ (Name of Participant) of ______________ (NRIC / Passport No.), hereby acknowledge that I consent to my *child/ward participation in the < W.O.W Race 2009 > on <28th February 2009>. I am aware of the possible risks involved and in consideration of my *child/ward being permitted by the <West Coast YEC> and the People’s Association Youth Movement (PAYM) to participate in the Race, I (a) do hereby absolve, acquit and discharge the PAYM and its officers, servants, employees, agents or volunteers from all or any responsibility, actions, causes of action, claims, demands and obligations whatsoever arising from any loss or damage (including, without limitation, physical injury, loss of life or property damage) caused by or sustained as a result of my *child’s/ward’s participation in the Race; and (b) will NOT hold the PAYM and its officers, servants, employees, agents or volunteers against all losses, claims, demands, actions, proceedings, damages, costs or expenses, including legal fees, and any other liability arising in any way from my *child’s/ward’s participation in the Race. _______________________________
_______________________________
Name of *Parent/Guardian
*Parent’s/ Guardian’s Signature & Date
In case of emergency, please contact Name of Parent / Guardian (*Dr/Mr/Mrs/Mdm/Ms): Relationship to Participant: Home No.: Office No.: Mobile No.: Email Address:
Organized by West Coast CC Youth Executive Committee (YEC), Hwa Chong Institution and West Coast Eagle Scout Group
WONDERS OF THE WEST (W.O.W) ADVENTURE RACE 2009 REGISTRATION FORM MEDICAL DECLARATION Please tick ( ) where applicable.
HAVE YOU EVER HAD
No
Yes
If YES, please provide brief description such as when, diagnosis, treatment, medication was received and whether the condition is stable.
a) High Blood Pressure b) Diabetes c) Asthma d) Tuberculosis e) Heart Disease f) Bone or Joint Injury g) Skin Diseases h) Physical Disabilities i) Hearing Problem j) Eye Problem (excluding short-sightedness) k) Neurological problems (example fits, stroke) l) Nervous problem (e.g. anxiety, schizophrenia) m) Operations or admission to hospital n) Allergy to medicine/food o) Other Medical Problems/Conditions (include pregnancy) SELF-DECLARATION I declare that all the information given above is true and correct.
________________________________
____________________________
Participant’s name
Participant’s Signature and Date
Organized by West Coast CC Youth Executive Committee (YEC), Hwa Chong Institution and West Coast Eagle Scout Group
WONDERS OF THE WEST (W.O.W) ADVENTURE RACE 2009 REGISTRATION FORM (Optional) CERTIFICATION BY CLINIC / MEDICAL EXAMINER (APPLICABLE FOR ‘YES’ DECLARATIONS) I have examined ______________________ (name) on ____________ (date) and found him/her *FIT / UNFIT to participate in the Race above.
Remarks, if any: ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________
_______________________
___________________
____________
Name of medical examiner
Signature and date
Clinic stamp
Organized by West Coast CC Youth Executive Committee (YEC), Hwa Chong Institution and West Coast Eagle Scout Group
