SNOW JAM divisions - please tick division to enter - $30 per entry

CENTRAL COAST BILLY JAM ENTRY FORM - PLEASE COMPLETE IN FULL.

the original snowboarding store - www.essboardstore.com.au

Womens Open Ski Open ProOpen Amateur

TO ENTER PLEASE HAVE $30 CASH & THIS ENTRYFORM WITH YOU ON THE DAY

I __________________________the undersigned participant, request the permission for myself to participate in the ESS SNOW RAIL COMPETITION the ‘Flux Billy Jam’ on this 24th day of May 2014.

I consent to participate in the activity and acknowledge that I fully understand my participation may involve risk of serious injury or death, including losses which may result not only from my own actions, inactions or negligence, but also from the actions, inactions, or negligence of others, the condition of the facilities, equipment, or areas where the activity is being conducted, and/or the rules of play of this type of activity. I understand that if I have any risk concerns, I should discuss them with the activity coordinators and sta� before I sign this document and before the activity begins.

I certify that I am in good health and have no physical condition that would prevent my participation in this activity. Furthermore, I agree to use my personal medical insurance as a primary medical coverage payment if accident or injury occurs. I consent to emergency medical treatment in the event such care is required.

I agree that photographs, pictures, slides, movies, video, or other media coverage of me may be taken in connection with my participa-tion in the activity without compensation from ESS or associates. Knowing and understanding the risks involved with participation in the activity, I hereby voluntarily and willingly assume responsibility for all risks and dangers associated with my participation in the activity. I agree I am �nancially responsible for any losses resulting from my actions during this activity.

I agree to wear a helmet either of my own or supplied by ESS at all times of competition. I understand that failure to comply in this matter will result in my removal from this competition. Also, I acknowledge that consuming alcohol or taking any drugs (whether prescribed or otherwise) during my participation in the activity is strictly prohibited and that my failure to comply with this further requirement will also result in my removal from this competition.

In consideration of my participation in the activity, I hereby waive all claims or causes of action against the event holder and the facility owner arising out of my participation in the activity and hereby release the event holder and facility owner from all liability in connec-tion therewith except such loss or damage which was caused by the sole negligence or wilful misconduct of the event holder and facility owner.

I have read this release agreement and understand the terms used in it and their legal signi�cance. This release is freely and voluntarily given with the understanding that right to legal recourse against the event holder and facility owner is knowingly given up in return for allowing my participation in the activity. My signature on this document is intended to bind not only myself but also my successors, heirs, representatives, administrators, and assigns.

First Name: Last Name:

Email:

ZIP Code:Address:

Phone:

CHECK-IN ESS BoardStoreSaturday the 24th May 2014 - 10.30am at ESS

INFO Please Bring your own Board & Boots on the day. Helmets Are required - we can supply one if you dont have your own.

Applicants Signature Parents Signature Date:(if under 18years old)