Round one Warriors – The Bike Shack

ENTRY FORM

First name

Surname

Mobile number

Emergency contact name

Emergency mobile number

Medical aid company

Medical aid number

Indemnity

Clause (1)
I, the participant and any of my spectators, followers/seconds/assistance and any persons related to my participation. Hereby indemnifies and holds “ GREATE ESCAPES ” harmless against liability for any prejudice, injury, harm, loss, damage or death that may be suffered by the said participant, and/or such damages, costs and expenses that may otherwise arise or be attributable to “ GREAT ESCAPES ” as a result of participation in this sporting event referred to above which shall include an indemnity against recovery of costs resulting from damage, loss and/or medical conditions or hospitalisation as well as any loss of or damage to the participants property and/or possessions .

It is acknowledged that the designated person/s, or company/ies sponsoring; employed by/ or assisting with the “ GREAT ESCAPES ” event are not liable in anyway, as in clause (1)

OTHER :
The participant grants permission to “ GREAT ESCAPES” to utilise photographs of the person/s, obtained at any point of the event on social media as well as in any advertising material that “The Bike ShackourtiGlisreastiEnscapes utilises in order to promote its brand; provided that same shall relate solely and exclusively to the specific event he/she has been participating in.

Banking Details:

TYME BANK
Acc: 5107 5608 065
REFERENCE YOUR FULL NAME

For any further information, please email :
greatescapes.za@gmail.com