2004 Canadian Lifeguard Championship Pool

2014 CANADIAN POOL LIFESAVING CHAMPIONSHIPS Registration Package

DATE April 26-27, 2014

LOCATION Edmonton, Alberta - Kinsmen Sports Centre, 9100 Walterdale Hill

SANCTIONING The 2014 Canadian Pool Lifesaving Championships is a Royal Life Saving Society Canada (RLSSC) National Championship that has been sanctioned by the International Life Saving Federation (ILS). Rules governing this Championships will include those from the Canadian Competition Manual (2012 Edition) and ILS Competition Manual (2013 edition).

ENTRY DEADLINE Registration and complete entries must be received by Friday, April 11, 2014. Registration and entries are considered to be complete when all documents and full payment have been received by Lifesaving Society Alberta and Northwest Territories Branch. Late registration fee may apply.

 Team Registration Form completed in full  Payment in full  Waiver and Release form (originals may be provided at registration)  Each competitor’s Registered Athlete number with a copy of current Lifesaving Society award (Bronze Medallion candidate award or higher), proof of age and proof of Canadian citizenship (birth certificate, passport or permanent resident card)

ENTRY FEES Competitor Fee $80.00 per athlete Late Fee $100.00 per athlete

REGISTRATION Send registration form with payment in full - cheque (payable to the Lifesaving Society), invoice (PO), Money Order, VISA, and MasterCard to:

Lifesaving Society Attention: Janice Vik 13123-156th Street Edmonton, Alberta T5V 1V2 Email: [email protected] Phone: 780-415-1755 Fax: 780-427-9334

ACCOMMODATION The Holiday Inn Express Downtown is located at 10010-104 Street NW, approximately three (3) km north of the Kinsmen Sports Centre. Call 1-877-423-4656 or 780-423-2450 for reservations. Please indicate “2014 Canadian Pool Lifesaving Championships” to receive the rate. Check in is at 4:00 p.m. and check out is at Noon. Parking will be available at a cost of $11.00/day. Bookings must be made before April 4, 2014 in order to receive the rate. For further details visit www.hiexdowntown.com.

LIFESAVING SOCIETY | 2014 CANADIAN POOL LIFESAVING CHAMPIONSHIP REGISTRATION PACKAGE 1 Schedule of Events (Subject to change)

EVENTS 100m Tow with Fins 100m /200m Obstacle Swim 4 x 50m Medley Relay 100m Rescue Medley 100m /200m Super Lifesaver 4 x 25m Manikin Relay 50m Manikin Carry Line Throw 4 x 50m Obstacle Relay 100m Carry with Fins

Friday, April 25 1600-1900 Coaches Check In Kinsmen Sports Centre

Saturday, April 26

Time Activity Location 0700 Facility Open Kinsmen Sports Centre 0730 Warm –Up Main Pool 0730 Coaches Meeting Multipurpose Room (On Deck) 0800 Officials Meeting Multipurpose Room (On Deck) 0845 Opening Ceremony 0915 Marshalling Session 1 0930 Start of Session 1 Final -100m Obstacle Preliminaries - 200m Obstacle, 4x 50m Obstacle Relay, 50m Carry with Fins, Line Throw, 100m Rescue Medley 1230 Lunch 1330 Presentation 1400 Warm –Up Main Pool 1500 Marshalling Session 2 1530 Start of Session 2 Finals – 200m Obstacles Presentation Finals – 4x50m Obstacle Relay Presentation Finals – 50m Carry with Fins Presentation Finals – Line Throw Presentation Finals – 100m Rescue Medley Following Presentation Kinette Room last event

LIFESAVING SOCIETY | 2014 CANADIAN POOL LIFESAVING CHAMPIONSHIP REGISTRATION PACKAGE 2 Schedule of Events (Subject to change)

Sunday, April 27

Time Activity Location 0700 Facility Open Kinsmen Sports Centre 0730 Warm –Up Main Pool 0730 Coaches Meeting Multipurpose Room (On Deck) 0800 Officials Meeting On Deck 0845 Presentation 0915 Marshalling Session 3 0930 Start of Session 1 Final - 100m Super Lifesaver Preliminaries - 200m Super Lifesaver, 50m Manikin Carry, 100m Tow w Fins, 4x 25m Manikin Relay, 4x 50m Medley Relay 1230 Lunch 1330 Presentation 1400 Warm –Up Main Pool 1515 Marshalling Session 4 1530 Start of Session 4 Finals – 200m Super Lifesaver Presentation Finals – 100m Manikin Carry with Fins Presentation Finals – 4x 25m Manikin Relay Presentation Finals – 100m Tow with Fins Presentation Finals – 4x 50m Medley Relay Presentation Following Presentation Kinette Room last event

LIFESAVING SOCIETY | 2014 CANADIAN POOL LIFESAVING CHAMPIONSHIP REGISTRATION FORM 3 Team Registration Form

Contact information/Coordonnées pour rejoindre l’équipe Club or Affiliate/Nom du Club ou Affilié: Name/ Nom:

Coach/Entraîneur or/ou Manager/Gérant Mailing Address/Adresse postale:

Phone/Téléphone: Fax/Télécopieur:

Email/Courriel: City/Ville Province Postal Code/Code postal

Entries will be confirmed by Email/Votre inscription vous sera confirmée par courriel. Please print clearly Écrivez lisiblement s.v.p. Registration Fees/Frais d’inscription How Description Price each/ Line total/ many? Coût de l’unité Total de cette Combien? ligne Competitor Fee $80.00 Frais de concurrent Late Competitor Fee $100.00

Total $ Payment/Paiement Payment method/ Cheque / Chèque Money Order / Mandat VISA MasterCard Mode de paiement Invoice Credit card number/ Expiry date/date d’expiration Numéro de la carte de crédit Credit card holder/Nom du titulaire de la carte de crédit Signature of credit card holder/ Signature du titulaire de la carte Phone/Email (if different than above)/Téléphone/courriel (s’il est différent de celui ci- dessus)

LIFESAVING SOCIETY | 2014 CANADIAN POOL LIFESAVING CHAMPIONSHIP REGISTRATION FORM 4 2014 Canadian Pool Lifesaving Championships  Championnats canadiens de sauvetage en piscine 2014 16-19 yrs. Entry Form / Formulaire d’inscription pour les épreuves Jeunes Sauveteur Event entries must indicate personal best times for seeding purposes. Competitors for who no times are submitted will be considered to have the slowest times. Competitors are allowed to enter each event only once. L’inscription aux épreuves doit inclure les meilleurs temps à des fins de pondération. Les athlètes qui ne fournissent pas de temps se verront attribués les temps les plus bas. Les athlètes peuvent participer une seule fois à chaque épreuve. PLEASE PRINT CLEARLY. ÉCRIVEZ LISIBLEMENT S.V.P.

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LIFESAVING SOCIETY | 2014 CANADIAN POOL LIFESAVING CHAMPIONSHIP REGISTRATION FORM 5

2014 Canadian Pool Lifesaving Championships  Championnats canadiens de sauvetage en piscine 2014 Open Entry Form / Formulaire d’inscription pour les épreuves Seniors Event entries must indicate personal best times for seeding purposes. Competitors for who no times are submitted will be considered to have the slowest times. Competitors are allowed to enter each event only once. L’inscription aux épreuves doit inclure les meilleurs temps à des fins de pondération. Les athlètes qui ne fournissent pas de temps se verront attribués les temps les plus bas. Les athlètes peuvent participer une seule fois à chaque épreuve. PLEASE PRINT CLEARLY. ÉCRIVEZ LISIBLEMENT S.V.P.

Competitor Name/ Indicate team / Nom de l’athlète Indiquez les sous équipes par numéro

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LIFESAVING SOCIETY | 2014 CANADIAN POOL LIFESAVING CHAMPIONSHIP REGISTRATION FORM 7 2014 Canadian Pool Lifesaving Championships  Championnats canadiens de sauvetage en piscine 2014 Masters Entry Form / Formulaire d’inscription pour les épreuves Maitres Event entries must indicate personal best times for seeding purposes. Competitors for who no times are submitted will be considered to have the slowest times. Competitors are allowed to enter each event only once. L’inscription aux épreuves doit inclure les meilleurs temps à des fins de pondération. Les athlètes qui ne fournissent pas de temps se verront attribués les temps les plus bas. Les athlètes peuvent participer une seule fois à chaque épreuve. PLEASE PRINT CLEARLY. ÉCRIVEZ LISIBLEMENT S.V.P.

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LIFESAVING SOCIETY | 2014 CANADIAN POOL LIFESAVING CHAMPIONSHIP REGISTRATION FORM 8

LIFESAVING SOCIETY | 2014 CANADIAN POOL LIFESAVING CHAMPIONSHIP REGISTRATION FORM 9 Waiver and Release Form Please read carefully before signing

Each competitor must sign this form and the entry form to be eligible to compete. Participants 18 years and under must have the form signed by their parent or guardian. 1. Conduct I agree to abide by the rules, regulations, and code of conduct of the championship, and further to behave in a manner consistent with good sportsmanship. 2. Voluntary Assumption of Risk As a competitor in a lifeguard competition, I recognize that there are certain risks inherent in the activity as a result of factors including but not limited to: stress, number of people, water temperature and conditions. I have prepared myself for the competition and know of no factor or condition which should be disclosed to the organizers or which would make it unsafe for me to compete. I voluntarily assume all risks, both physical and legal including but not restricted to loss or damage to property, and personal injury including permanent disability or death. 3. Waiver of Liability As a condition of entry and in consideration of my application as an individual or as part of a team being accepted, I hereby waive my right to make any claim, whether for negligence or otherwise against the Lifesaving Society, the City of Edmonton, the Kinsmen Sport Center, the owner or occupier, the sponsors, the organizing committee or any of the servants, agents, affiliates, volunteers, judges, officials, or other persons involved in the organization of and the running of the competition, events or sanctioned associated activities. I further agree to indemnify and hold harmless all of the above, from any claim made on my behalf or as a result of injury to my person or property. 4. Model Release I transfer to the Lifesaving Society all rights whatsoever which I have in photographs and/or videos that photographers may have taken. I consent to the use of the photographs/videos and my name for all purposes whatsoever, including without limitation, television, publications, and any trade or advertising purposes.

I have carefully read and understand the four conditions of entry and in consideration for being allowed to compete, I have executed them voluntarily intending to be bound thereby and intending these conditions to be binding of my heirs, personal representative and assigns.

LIFESAVING SOCIETY | 2014 CANADIAN POOL LIFESAVING CHAMPIONSHIP REGISTRATION FORM 10 Print Name Signature Date

Coach

Manager

Captain

#8 Photocopy this page if you need to included additonal athletes.

LIFESAVING SOCIETY | 2014 CANADIAN POOL LIFESAVING CHAMPIONSHIP REGISTRATION FORM 11 Formulaire de dispense et d’exonération Veuilles lire attentivement avant de le signer

Veuillez lire attentivement ce document avant de le signer. Les athlètes mineurs (moins que 18 ans) doivent compléter le formulaire avec la signature d’un parent ou du tuteur. 5. Comportement J’accepte de me conformer aux règlements et au code d’éthique du championnat et de me conduire d’une façon qui va en concordance avec les idéaux d’un bon esprit sportif. 6. Consentement aux risques encourus En tant qu’athlète participant à la compétition, je reconnais qu’il y a certains risques inhérents à celle-ci. Les risques sont reliés aux facteurs suivants, mais ne se limitant pas à ceux-ci : le stress, le nombre de personnes, les conditions et la température de l’eau. De plus, il n’y a aucun facteur ou condition que je devrais dévoiler aux organisateurs qui rendrait dangereuse ma participation à cette compétition. J’accepte de mon plein gré tous les risques physiques autant que légaux reliés à ma participation, incluant mais ne se limitant pas à : perte ou dommage à la propriété, blessure personnelle incluant un handicap permanent ou la mort. 7. Exonération de responsabilité Comme condition à mon inscription en tant qu’individu et membre d’une équipe, je renonce à tous mes droits d’intenter une poursuite que ce soit pour négligence ou autre envers la Société de Sauvetage, la Ville d` Edmonton, le Center de Sport Kinsmen, les opérateurs, les propriétaires ou occupants de l’installation, les commanditaires, le comité organisateur, les agents, les affiliés, les bénévoles, les juges et officiels ou tout autre personne impliquée dans l’organisation ou la tenue de la compétition, des épreuves et des activités connexes. J’accepte de plus d’indemniser et de ne pas tenir responsable toutes les personnes nommées ci-dessus, de toute réclamation faite en mon nom ou suite à une blessure à ma personne ou ma propriété. 8. Dispense du participant J’accorde à la Société de sauvetage tous les droits quels qu’ils soient pour ce qui est des photographies et/ou des vidéos qui auront été pris lors de la compétition. Je consens à ce que les photographies et les vidéos et mon nom soient utilisés pour n’importes quels médias, sans limite, soit la télévision, les revues et dans tout but d’échange ou de promotion. J’ai lu attentivement et je comprends clairement les quatre conditions de mon inscription et de ma participation à cette compétition. J’y consens de plein gré et j’ai l’intention que mes héritiers, mes représentants personnels et ayants droits les respectent eux aussi.

LIFESAVING SOCIETY | 2014 CANADIAN POOL LIFESAVING CHAMPIONSHIP REGISTRATION FORM 12 Nom en lettres moulées Signature Date

Entraîneur

Manager

Captain

#8 Photocopiez ce formulaire si vous avez un plus grand nombre d’athlète

LIFESAVING SOCIETY | 2014 CANADIAN POOL LIFESAVING CHAMPIONSHIP REGISTRATION FORM 13