2012 CPLCs - Complete registration package
Transcription
2012 CPLCs - Complete registration package
2012 CANADIAN POOL LIFESAVING CHAMPIONSHIPS JUNE 1 - 2 - 3 KINSMEN SPORT CENTRE - 9100 WALTERDALE HILL Tel: 780 415 1755 | Fax: 780 427 9334 11759 Groat Road | Edmonton, AB | T5M 3K6 | Canada www.lifesaving.org 2012 CANADIAN POOL LIFESAVING CHAMPIONSHIPS CHAMPIONNATS CANADIENS DE SAUVETAGE EN PISCINE 2012 Registration Package DATE June 1–3, 2012 HOST Lifesaving Society Alberta and Northwest Territories Branch LOCATION Kinsmen Sports Centre, Edmonton, Alberta SANCTIONING The 2012 Canadian Pool Lifesaving Championships has been sanctioned by the International Life Saving Federation (ILS) and the Royal Life Saving Society Canada (RLSSC) and as such, any World Records that may be broken will be recorded and submitted to ILS for processing. Rules governing this championships will include those from the ILS Competition Manual (2011 edition) and Canadian Competition Manual (2010 Edition). FORMAT Lifesaving Society “SANCTIONED EVENT WARM-UP PROCEDURES” will be in effect through the championships. All Masters events will be swam as time finals in the morning. Finals will be conducted in the 16-19 years and Open Division according to the Canadian Competition Manual. EVENTS 100m Tow with Fins 100m Rescue Medley 50m Manikin Carry 100m Carry with Fins POOL SPECS The swimming pool at the Kinsmen Sports Centre is 2.2m deep for the entire length of the pool. There are eight lanes with two outside gutter lanes of 2.5m on either side of the pool. There is a minor slope discrepancy from Lane 1 to Lane 10 to accommodate drainage. The pool edges are rounded meaning that manikins will not be flush with the wall. EQUIPMENT The host will supply Aquam Rescue Tubes, DLRG Manikins, custom obstacles and Throw Lines from Canada Cordage for the use of competitors during competition. All competitors are required to supply their own fins. 100m /200m Obstacle Swim 4 x 50m Medley Relay 100m /200m Super Lifesaver 4 x 25m Manikin Relay Line Throw 4 x 50m Obstacle Relay All equipment will comply with the ILS specifications as specified in the ILS Competition Manual section 10.0 AWARDS Awards will be issued in accordance with 2010 Canadian Competition Manual ENTRY DEADLINE Registration and complete entries must be received by Friday, May 18, 2012. Registration and entries are considered to be complete when all of the following have been completed in full and received by [email protected] Registration Form (including male and female event entry forms) Payment in full LIFESAVING SOCIETY | 2012 CANADIAN POOL LIFESAVING CHAMPIONSHIP REGISTRATION FORM 2 2012 CANADIAN POOL LIFESAVING CHAMPIONSHIPS CHAMPIONNATS CANADIENS DE SAUVETAGE EN PISCINE 2012 Waiver and Release form (originals may be provided at registration) Hold a current Lifesaving Society Bronze Medallion or higher Be a minimum of 16 years of age at of the first day of the Championships Be a Registered Athlete (download form at www.lifesavingsport.ca) ENTRY FEES Competitor Fee $80.00 per athlete Late Fee (after May 18, 2012) APPEALS $100.00 per athlete The Competition Appeals Committee will deal with all the protests referred to it by the Referee. The appeals process is detailed in the current ILS Competition Manual. Appeals forms can be obtained from the appointed Competitor Liaison. The Competition Appeals Committee shall consider the protest or appeal and make a decision. It may uphold or dismiss a protest or appeal. The cost of lodging an appeal is $100.00 including GST. If an appeal is upheld the fee shall be returned. The decision of the competition appeals committee is final and there is no right of appeal against that decision. DRUG POLICY Royal Life Saving Society Canada supports the Canadian Government, the Canadian Sports Commission, the Canadian Olympic Committee, and the World Anti-Doping Authority (WADA) in their efforts to eradicate the use of drugs in sport. These policies will be adhered to for this event. Please also be aware that random drug testing could take place during the 2012 Canadian Pool Lifesaving Championships. ACCOMMODATION AND OPTIONS The Athlete Village will be hosted by Grant MacEwan University located in the heart of downtown Edmonton. The University will be the site of Registration and Check In, Welcome Reception and Closing Ceremony and reception as well as the athletes, officials and family accommodations. The residence is located at 11050 - 104th Avenue, approximately three km north of the Kinsmen Sports Centre. Transportation is also available for a minimal fee. Amenities within walking distance include Save-On-Foods, Safeway, Hudson’s Canadian Tap House, Future Shop and all major banks. Bachelor Suite Hotel Rooms (Queen) 2 Bedroom Suite 4 Bedroom Suite $65.00/night $72.40/night $80.00/night $160.00/night Please see accommodations booking information for further details or visit www.macewanresidence.ca for a virtual tour. LIFESAVING SOCIETY | 2012 CANADIAN POOL LIFESAVING CHAMPIONSHIP REGISTRATION FORM 3 2012 CANADIAN POOL LIFESAVING CHAMPIONSHIPS CHAMPIONNATS CANADIENS DE SAUVETAGE EN PISCINE 2012 RECEPTIONS The Society will be hosting a Welcome Reception on Friday evening for all registered athletes, officials, and volunteers. A Closing Ceremony and reception will also be hosted on Sunday evening for all registered athletes, officials, and volunteers. Lifesaving Society Sport Awards and Overall Championships awards in accordance will the 2010 Canadian Competition Manual will be presented at this time. Both receptions are casual dress. REGISTRATION Please complete the appropriate forms along with payment in full: PAYMENT Championships Registration Form (including payment) Event Entry Form Waiver and Release Form Registered Athletes Form Cheques should be made payable to the Lifesaving Society. We also accept payment by invoice (PO) Money Order, VISA, and MasterCard. Lifesaving Society Attention: 2012 Canadian Pool Lifesaving Championships 11759 Groat Road, Edmonton, Alberta T5M 3K6 Email: [email protected] Phone: 780-415-1755 Fax: 780-427-9334 ACCOMODATION Athlete Village: Grant MacEwan University Grant MacEwan Reservation Form LIFESAVING SOCIETY | 2012 CANADIAN POOL LIFESAVING CHAMPIONSHIP REGISTRATION FORM 4 2012 CANADIAN POOL LIFESAVING CHAMPIONSHIPS CHAMPIONNATS CANADIENS DE SAUVETAGE EN PISCINE 2012 Friday June 1, 2012 12:00 p.m. – 5:00 p.m. 4:00 p.m. – 5:00 p.m. 8:00 p.m. Saturday, June 2, 2012 Check-In Key Officials Meeting Welcome Reception Paul Byrne Hall Grant MacEwan University Paul Byrne Hall Grant MacEwan University Paul Byrne Hall Grant MacEwan University 7:00 a.m. – 7:45 a.m. 7:00 a.m. – 7:30 a.m. 7:30 a.m. – 8:00 a.m. 8:00 a.m. 8:15 a.m. 8:30 a.m. – 12:30 p.m. Warm –Up Kinsmen Sports Centre Coaches Meeting Officials Meeting Marshalling Session 1 Opening Ceremonies Start of Session 1 Preliminaries 100m Rescue Medley 100m Carry w Fins Line Throw 100M/ 200m Obstacles 4x 50m Obstacles Relay BREAK Warm –Up Kinsmen Sports Centre 3:00 p.m. – 3:45 p.m. 3:00 p.m. – 3:30 p.m. 3:30 p.m. 4:00 p.m. 4:30 p.m. – 6:30 p.m. Sunday, June 3, 2012 7:00 a.m. – 7:45 a.m. 7:00 a.m. – 7:30 a.m. 7:30 a.m. – 8:00 a.m. 8:00 a.m. 8:30 a.m. – 12:30 p.m. 3:00 p.m. – 3:45 p.m. 3:00 p.m. – 3:30 a.m. 3:30 p.m. 4:00 p.m. 4:30 p.m. – 6:30 p.m. 8:00 p.m. Coaches Meeting Officials Meeting Marshalling Session 2 Finals Start of Session 2 100m Rescue Medley 100m Carry w Fins 100m Rescue Medley Awards Line Throw 100m Carry w Fins Awards 200m Obstacles Line Throw Awards 4x 50m Obstacles Relay 200m Obstacles Awards Warm –Up Kinsmen Sports Centre Coaches Meeting Officials Meeting Marshalling Session 3 Start of Session 3 Preliminaries 100M/ 200m Super Lifesaver 50m Manikin Carry 100m Tow w Fins 4x 25m Manikin Relay 4x 50m Medley Relay BREAK Warm –Up Coaches Meeting Officials Meeting Marshalling Session 4 Start of Session 4 Finals 200m Super Lifesaver 50m Manikin Carry 100m Tow w Fins 4x 25m Manikin Relay 4x 50m Medley Relay Closing Reception Atrium, Grant MacEwan University LIFESAVING SOCIETY | 2012 CANADIAN POOL LIFESAVING CHAMPIONSHIP REGISTRATION FORM 5 2012 CANADIAN POOL LIFESAVING CHAMPIONSHIPS CHAMPIONNATS CANADIENS DE SAUVETAGE EN PISCINE 2012 Program of Events -- 1 -- 1 1 1 -- 1 4x 50m Medley Relay 4x50m Obstacles Relay 1 4x 25m Manikin Relay Lifesaving Penthalon 1 Line Throw 200m Super Lifesaver 100m Carry w Fins 100m Super Lifesaver 100m Tow w Fins 1 50m Manikin Carry -- Team Events Masters (30-34 yrs) 100m Rescue Medley Open (16 yrs & Over) 200m Obstacles 16-19 yrs 100m Obstacles Age Categories Individual Events For the 2012 Canadian Pool Lifesaving Championships, the following events shall be conducted in both male and female categories: 1 1 2 2 2 -- -- -- -- -- -- 2 2 2 Masters (40-44 yrs) -- -- -- 2 2 2 Masters (45-49 yrs) -- -- -- 2 2 2 Masters (50-54 yrs) -- -- -- 2 2 2 Masters (55-59 yrs) -- -- -- 2 2 2 Masters (60-64 yrs) -- -- -- 2 2 2 Masters (65 & Over) -- -- -- 2 2 2 Masters (35-39 yrs) 1 2 The Lifesaving Pentathlon is comprised of the following five (5) events Masters team events are conducted as total age events in the following age categories; 120 years +, 140 years +, 170 years +, and 200 years + LIFESAVING SOCIETY | 2012 CANADIAN POOL LIFESAVING CHAMPIONSHIP REGISTRATION FORM 6 2012 CANADIAN POOL LIFESAVING CHAMPIONSHIPS CHAMPIONNATS CANADIENS DE SAUVETAGE EN PISCINE 2012 Championships Event Schedule SESSION 1 SATURDAY JUNE 2, 2012 PRELIM WARM UP 07:00 AM START 08:30 AM 16‐19 100m Rescue Medley 16‐19 OPEN 100m Rescue Medley OPEN 16‐19 100m Carry w Fins 16‐19 OPEN 100m Carry w Fins OPEN 16‐19 200m Obstacles 16‐19 OPEN 200m Obstacles OPEN MASTERS 100m Obstacles MASTERS 16‐19 Line Throw 16‐19 OPEN Line Throw OPEN 16‐19 4x 50m Obstacles Relay 16‐19 OPEN 4x 50m Obstacles Relay OPEN SESSION 2 SATURDAY JUNE 2, 2012 FINALS WARM UP 03:00 PM START – 04:30 PM 16‐19 100m Rescue Medley 16‐19 OPEN 100m Rescue Medley OPEN 16‐19 100m Carry w Fins 16‐19 OPEN 100m Carry w Fins OPEN 16‐19 200m Obstacles 16‐19 OPEN 200m Obstacles OPEN 16‐19 Line Throw 16‐19 OPEN Line Throw OPEN 16‐19 4x 50m Obstacles Relay 16‐19 OPEN 4x 50m Obstacles Relay OPEN LIFESAVING SOCIETY | 2012 CANADIAN POOL LIFESAVING CHAMPIONSHIP REGISTRATION FORM 7 2012 CANADIAN POOL LIFESAVING CHAMPIONSHIPS CHAMPIONNATS CANADIENS DE SAUVETAGE EN PISCINE 2012 Championships Event Schedule (continued) SESSION 3 SUNDAY JUNE 3, 2012 PRELIM WARM UP 07:00 AM START 08:30 AM 16‐19 200m Super Lifesaver 16‐19 OPEN 200m Super Lifesaver OPEN MASTERS 100m Super Lifesaver MASTERS 16‐19 50m Manikin Carry 16‐19 OPEN 50m Manikin Carry OPEN 16‐19 100m Tow w Fins 16‐19 OPEN 100m Tow w Fins OPEN 16‐19 4x 25m Manikin Relay 16‐19 OPEN 4x 50m Medley Relay OPEN 16‐19 4x 25m Manikin Relay 16‐19 OPEN 4x 50m Medley Relay OPEN SESSION 4 SUNDAY JUNE 3, 2012 FINALS WARM UP 03:00 PM START 04:30 PM 16‐19 200m Super Lifesaver 16‐19 OPEN 200m Super Lifesaver OPEN 16‐19 50m Manikin Carry 16‐19 OPEN 50m Manikin Carry OPEN 16‐19 100m Tow w Fins 16‐19 OPEN 100m Tow w Fins OPEN 16‐19 4x 25m Manikin Relay 16‐19 OPEN 4x 25m Manikin Relay OPEN 16‐19 4x 50m Medley Relay 16‐19 OPEN 4x 50m Medley Relay OPEN LIFESAVING SOCIETY | 2012 CANADIAN POOL LIFESAVING CHAMPIONSHIP REGISTRATION FORM 8 2012 CANADIAN POOL LIFESAVING CHAMPIONSHIPS CHAMPIONNATS CANADIENS DE SAUVETAGE EN PISCINE 2012 Championship 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 Phone/Téléphone: Unattached/ Non attacé: Mailing Address/Adresse postale: 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 many? Combien? Description Price each/ Coût de l’unité Competitor Fee Frais de concurrent Late Competitor Fee L'Entrée d'événement Line total/ Total de cette ligne $80.00 $100.00 Total $ Payment/Paiement Payment method/ Mode de paiement Credit card number/ 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) Cheque / Chèque Money Order / Mandat LIFESAVING SOCIETY | 2012 CANADIAN POOL LIFESAVING CHAMPIONSHIP REGISTRATION FORM VISA MasterCard Invoice Expiry date/date d’expiration 9 2012 CANADIAN POOL LIFESAVING CHAMPIONSHIPS CHAMPIONNATS CANADIENS DE SAUVETAGE EN PISCINE 2012 2012 Canadian Pool Lifesaving Championships Championnats canadiens de sauvetage en piscine 2012 Event Entry Form / Formulaire d’inscription pour les épreuves Event entries must indicate personal best times for seeding purposes. Competitors for whom 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. Last name, First name Nom de famille, prénom Last name, First name Nom de famille, prénom Last name, First name Nom de famille, prénom Last name, First name Nom de famille, prénom Last name, First name Nom de famille, prénom Last name, First name Nom de famille, prénom 3:10.70 1:20:00 3:10.70 59.70 20.00 4 x 25m Manikin Relay Relais mannequin 4 x 25 m 4 x 50 m Medley Relay Relais 4 nages 4 x 50 m 4 x 50 m Obstacle Relay Relais obstacle 4 x 50 m 3:10.70 1:10.70 Line Throw Lancer de la corde 100 m Rescue Medley Sauvetage 4 nages sur 100 m 50 m Manikin Carry Portage d’un mannequin sur 50 m 100m/ 200m Super Lifesaver Sauveteur d’acier sur100m/ 200 m BRO224 100 m Carry with Fins Portage avec palmes sur 100 m 16-19 Indicate team / Indiquez les sous équipes par numéro Lifesaving Penthalon Pentathlon en sauvetage M F Phone/Téléphone: 100 m Tow with Fins Remorquage avex palmes sur 100 m Brown, John 100m/200mObstacle Swim Nage avec obstacles sur 100m 200 m Gender / Sexe Registered Athlete`s Numbe Nombre athlète Competitor Name/ Nom de l’athlète 16-19 OR OPEN OR Masters Jeunes sauveteur OU les séniors OU les maîtres PLEASE PRINT CLEARLY. ÉCRIVEZ LISIBLEMENT S.V.P. : Club or Affiliate / Le Club ou Affilie OR/OU Unattached / Sans attaches Coach/Entraîneur or/ou Email / Courriel Manager / Gérant Note: Line Throw: indicate team and thrower. Lancer de la corde : indiquez les sous équipes par numéro et lanceur / lanceuse 3:10.70 2:19.23 3:10.70 M F M F M F M F M F M F LIFESAVING SOCIETY | 2012 CANADIAN POOL LIFESAVING CHAMPIONSHIP REGISTRATION FORM 10 2012 CANADIAN POOL LIFESAVING CHAMPIONSHIPS 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, Grant MacEwan University, 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. Print Name Signature Date Coach Manager Captain #2 #3 #4 #5 #6 #7 #8 Photocopy this page if you need to included additonal athletes. LIFESAVING SOCIETY | 2012 CANADIAN POOL LIFESAVING CHAMPIONSHIP REGISTRATION FORM 11 CHAMPIONNATS CANADIENS DE SAUVETAGE EN PISCINE 2012 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. 1. 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. 2. 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. 3. 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, l`Universite de Grant MacEwan, 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. 4. 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. Nom en lettres moulées Signature Date Entraîneur Manager Captain #2 #3 #4 #5 #6 #7 #8 Photocopiez ce formulaire si vous avez un plus grand nombre d’athlète LIFESAVING SOCIETY | 2012 CANADIAN POOL LIFESAVING CHAMPIONSHIP REGISTRATION FORM 12 MacEwan Residence 11050 –104 Avenue Edmonton, AB T5K 2Y9 780-633-8000 780-633-8910 Lifesaving Society June 1 – 3, 2012 Reserve your accommodation by faxing, mailing or emailing this completed form to MacEwan Residence at: Fax: 780-633-8910 Mail: MacEwan Residence 11050 104 Ave Edmonton, AB T5K 2Y9 E-Mail: [email protected] Please indicate your arrival and departure dates Please indicate if you are an May 29 May 31 June 1 June 2 June 3 June 4 June 5 Coach/Team Manager Officials/Volunteer Athlete Family Last Name: ____________________ First Name: _________________ Address: ______________________________ City: __________________________ Prov. ______________ Postal Code: ___________________________ Res. Telephone: _________________ Cell/Work Phone: ______________ E-Mail Address: ________________________ (E-Mail where confirmation to be sent) Accommodations Request _____ 2 Bedroom Suite (Max. 4 people) $80/night # of guests _____ _____ Bachelor Suite (Max. 2 people) $65/night # of guests _____ _____ Hotel Room (Queen Double) $72.40/night # of guests _____ _____ 4 Bedroom Suite (Max. 8 people) $160/night # of guests _____ (Limited Availability) Rates are subject to 5% GST and 4% Alberta Tourism Levy. Shuttle and Parking Services _____ Shuttle Service $15/day/person # of guests requiring Shuttle Service _____ _____ Parking $5/night/vehicle # of guests requiring Parking Service _____ Rates are subject to 5% GST Meal Options ____ Sat., June 2: 6:00 a.m. – 7:00 a.m. - Breakfast $12.00/person Menu: Pancakes (2), Sausage (2) Scrambled Eggs, Fruit Salad, Juice, Coffee and Tea # of guests _____ _____ Sat., June 2: Pick up between 6:00 a.m. – 7:00 a.m. – Boxed Lunch $11.49/person # of guests______ Includes: Assorted 8-inch sub sandwich, veggies and dip, pasta salad, piece of whole fruit, dessert square, can of juice. ______ Sun., June 3: 6:00 a.m. – 7:00 a.m. - Breakfast $12.00/person Menu: Breakfast Wraps, Sausage (2), Pan Fries, Fruit Salad, Juice, Coffee and Tea # of guests _____ _____ Sun., June 3: Pick up between 6:00 a.m. – 7:00 a.m. – Boxed Lunch $11.49/person # of guests______ Boxed Lunch Includes: Assorted 8-inch sub sandwich, veggies and dip, pasta salad, piece of whole fruit, dessert square, can of juice _____ Monday, June 3: 7:00 a.m. – 8:00 a.m. - Breakfast $12.00/person # of guests______ Menu: French Toast, Ham, Scrambled Eggs, Fruit Salad, Juice, Coffee and Tea All taxes and gratuity are included in the price. If less than 25 guests participate in meal options, meals may be cancelled with prior notice given to guests. Cancellation Policy Cancellations and changes may be made to room reservations and shuttle service up to 48 hours prior to the scheduled arrival date. After this time, all charges for all nights’ accommodation and shuttle service will be applied to the credit card on file. There will be no refunds or adjustments for cancellations, no shows, late arrivals or early departures. Cancellations and changes may be made to food reservations up to 10 days prior to the scheduled arrival date. After this time, all charges for all meals will be applied to the credit card on file. There will be no refunds or adjustments for cancellations, no shows, late arrivals or early departures. Full payment for all nights’ accommodation, parking, shuttle and food services is due upon arrival All bedrooms are equipped with double beds; linen & towels are changed every three (3) days. Suites are not equipped with dishes or cooking utensils PLEASE NOTE: PLEASE FILL OUT THE CREDIT CARD AUTHORIZATION FORM ON PAGE 2 OF THIS FORM. NO RESERVATIONS WILL BE ACCEPTED WITHOUT THIS FORM COMPLETED. MacEwan Residence 11050 –104 Avenue Edmonton, AB T5K 2Y9 780-633-8000 780-633-8910 Grant MacEwan University MacEwan Residence Credit Card Authorization 1. Credit Card Information: O Visa O MasterCard _________________________________________ ___________ Card Number Expiry Date _________________________________________________ Cardholder Name ________________________________________ Cardholder Signature _________________________________________________ Cardholder Phone Number _________________________________________ Cardholder Email 2. Payment Authorization Information & Terms I understand that processing of payments for all nights accommodation and taxes for this booking will occur 48 hours prior to the scheduled arrival date. I authorize Grant MacEwan University to charge the credit card indicated in this document under the agreed terms. I understand that if the cardholder information is not my own, I must have this authorization signed by the cardholder before submitting payment authorization. I agree to notify MacEwan Residence of any changes in expiry date, account information, reservation dates, cancellations or termination of the authorization for payments. I have read, understand and agree to the terms of the MacEwan Residence 48 hour payment & cancellation policies. I understand that by signing and submitting this form, I have read and agree to the terms of this form. Reservation Holder Signature: ___________________________ Date: __________ Cardholder/Payee Signature: _________________________ Date: ___________ Please print, complete and scan to [email protected] OR fax authorization form to 780-633-8910 Personal information requested on this form is collected and protected under the authority of the Alberta Freedom of Information and Protection of Privacy Act. The information is used for the purposes of managing the accommodation arrangements. MacEwan Residence Internal use only Confirmation #_____________________ Entered by ______________________ Tent Room # _____________________ Confirmation sent __________________ By__________________________ Express check in Info sent __________ LIFESAVING SPORT – ATHLETE REGISTRATION FORM First Name: ____________________________ Last Name: ___________________________ Address: ____________________________________________________________________ City: _______________________ Province: ________________ Postal Code: ____________ Home Telephone #: ____________________ Date of Birth (y-m-d): _________ Gender: _____ LSS ID#: ______________ Email: _______________________________________________ Club/Affiliate: ________________________________________________________________ (If you are currently a Registered Athlete, you are not required to submit the following documents. Please provide your Registered Athlete Number: ____________________). Athletes must submit and attach at least one copy of legible documents that confirm and support each of (1) Canadian Citizenship (2) Date of Birth (3) Lifesaving Society Award (you must hold Bronze Medallion or higher certification): (1) Canadian Citizenship: (2) Date of Birth: (3) Lifesaving Award: Birth Certificate Birth Certificate Lifesaving Society Cert. Card or or Canadian Passport Canadian Passport or or Citizenship Card Citizenship Card DECLARATION: I hereby declare that the statements made in this application are true. Applicant’s signature: Date: Signed at: Year / Month / Day City / Province FOR OFFICE USE: DOCUMENTS RECEIVED Canadian Citizenship Birth Certificate Copy attached: Yes No Passport Copy attached: Yes No Birth Certificate Copy attached: Yes No Passport Copy attached: Yes No Lifesaving Society Certification Card Copy attached: Yes No Date of Birth Lifesaving Award Registered Athlete Number: _________________________ Please mail, fax or email to: Lifesaving Society, 400 Consumers Road, Toronto, Ontario M2J 1P8 fax: 416-490-8766 Email: [email protected]