Member Registration Application Form

CLIMBER REGISTRATION FORM – 2013

(Please note: should the participant be between the ages of 7 and 18, this registration form must be completed and signed by the minor being duly assisted by his/her guardian.)

 

ADMIN INFORMATION (To be completed by WCC or representing person)

 

Receipt No.:

Fee Paid:   R

SANCF Climber No.:

 

 

 

PERSONAL INFORMATION

 

Full Names:(hereinafter referred to as "the Participant")

 

Preferred Name:

Gender:(M/F)

Race(Black/Coloured/Indian/White):

(S A Govt. requires the above ethnicity.)

ID Number:

Tel. W:

H:

Cell:

Email:

Postal Address:

 

 

                                                                                                                                                Code:

Physical Address:

 

 

                                                                                                                                                Code:

         

 

EMERGENCY NFORMATION

 

Medical Aid:

No.:

Main Member:

Contact Details

1. Name:

Relationship:

Tel: H:

Cell:

W:

2. Name:

Relationship:

Tel: H:

Cell:

W:

       

 

Climber fees:

Club Fees                      R

Provincial Fees              R  40-00

SANCF Fees                   R120-00

TOTAL                    R160-00

 

Bank Account Details for the above Provincial and SANCF Fees:

Western Cape Climbing

FNB

Branch Code: 204209

Account Number: 62380592652

Cheque Account

 

Terms and Conditions

 

 

By his/her signature hereto, the Participant  agrees and undertakes in favour of the South African Climbing Federation ("SANCF") and any provincial body holding membership in SANCF, including  Western Cape Climbing as well as City Rock Climbing Gym,  The University of Cape Town Climbing Wall and any of the aforementioned entity's employees, officers, members,  servants and agents (hereinafter collectively referred to as “the Organisers”) that:

 

1.        he/she is aware of the dangers of personal injury or death inherent in mountaineering, hiking, scrambling, bouldering, rock climbing, indoor climbing and activities incidental thereto to which he/she may be exposed as a result of his/her participation in activities organised by or on behalf of the Organisers and he/she understands and accepts that his/her participation in any such activities is at his/her own risk for which he/she accepts all responsibility;

 

2.        he/she indemnifies the Organisers against any claim arising out of any injury, death, loss, demands, actions, judgments, damages, costs, expenses (including attorney's fees and expenses) and other liabilities of whatsoever nature which he/she may have arising out of or in connection with his/her participation in the Organisers’ activities and activities organised by or on behalf of the Organisers;

 

3.        should he/she be injured whilst participating in activities organised by or on behalf of the Organisers, he/she appoints and authorises the Event Organiser (or such other person who is co-ordinating the activity on behalf of the Organisers) to consent to him/her undergoing surgical or other medical treatment which in the opinion of the attending medical practitioner is necessary, should he/she be unable to grant his/her consent thereto. He/she further undertakes to pay the cost of such treatment;

 

4.        he/she agrees that the terms and conditions contained herein will remain binding upon him/her, his/her heirs, executors, administrators and assigns;

 

5.        he/she warrants and acknowledges that his/her general health is good and that there is nothing that renders him/her unfit to participate in the Organisers' activities;

 

6.        to the best of his/her knowledge the above information is current, correct and true.  He/she considers him/herself to be physically fit and capable of full participation;

 

7.        he/she shall inform the Club of any changes to his/her personal information; and

 

8.        he/she will abide by the SANCF Constitution and policies in force from time to time, including but not limited to the anti-doping policies (copies of which will be provided on request).

 

 

 

Participant's signature: ___________________________________________

 

 

Signature of parent/guardian: __________________________________

(if under the age of 18)

Date (dd/mm/yyyy):