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The following "Event Assumption of Risk, Declaration, Waiver, Indemnity and Release Form" has been approved by the Namibian Cycling Federation (the "NCF").  

In consideration of the issuance of a license to me by one or more Releasees or the acceptance of my application for entry in an event ("event") regulated by or associated with the NCF, I hereby freely agree to and make the following contractual representations and agreements:  

1.            Assumption of risk    

1.1           I acknowledge that I have been advised that and am aware that participation in the event involves significant risks of injury, trauma, harm and damage to me, my property, other participants, spectators and other persons attending or in the vicinity of the event and with this knowledge I voluntarily participate in the event fully accepting all such risks if they arise which may result in personal injury, death and damage. 
1.2           I acknowledge that cycling is an inherently dangerous sport and fully realize the dangers of participating in this event, whether as a rider, official, coach, mechanic, volunteer, spectator, or otherwise, and fully assume the risks associated with such participation including, by way of example, and not limitation: dangers associated with man-made and natural jumps; the dangers of collision with pedestrians, vehicles, other riders, and fixed or moving objects; the dangers arising from surface hazards, including pot holes, equipment failure, inadequate safety equipment, use of equipment or materials provided by the event organizer and others, the releasees' own negligence, the negligence of others and weather conditions; and the possibility of serious physical and/or mental trauma or injury, or death associated with the event, for myself, my heirs, executors, administrators, legal representatives, assignees, and successors in interest (collectively "successors"). 
2.            Representations and Warranties   
2.1           I agree it is my sole responsibility to be familiar with the event course and agenda, the releasees' rules, and any special regulations for the event and agree to comply with all such rules and regulations. 
2.2           I  have read it carefully before signing, and  I  understand what it means and what I  am agreeing to by signing.  
2.3           I have no physical or medical condition which would endanger myself or others if I participate in this event.  
2.4           I understand and agree that situations may arise during the event which may be beyond the control of the releasees, and I must continually ride and otherwise participate so as to neither endanger myself nor others. I accept responsibility for the condition and adequacy of my equipment, any equipment provided for my use, and my conduct in connection with this event. I will wear a helmet which satisfies the requirements of the releasees' racing rules or regulations and that can protect against serious head injury, and assume all responsibility and liability for the selection of such a helmet and any modifications and attachments made thereto.  
2.5            I  understand and agree that  the  UCI Anti-Doping Rules  apply to  me and  that  it is  my responsibility to comply with those rules. I agree to submit to drug testing and understand that the use of methods or substances prohibited by the applicable anti-doping rules would make me subject to penalties including, but not limited to, disqualification and suspension. If it is determined that I may have committed a doping violation, I agree to submit to the results management authority of the UCI and my national federation.    
2.6            I  agree, for myself and my successors, that the above representations are contractually binding, and are not mere recitals, and that should I or my successors assert a claim contrary to what I have agreed to in this contract, the claiming party shall be liable for the expenses (including legal fees) incurred by the releasees in defending the claims.  
2.7            This contract may not be modified orally, and a waiver or modification of any provision shall not be construed as a waiver or modification of any other provision herein or as a consent to any subsequent waiver or modification. Every term and provision of this contract is intended to be severable. If any one or more of them is found to be unenforceable or invalid, that shall not affect the other terms and provisions, which shall remain binding and enforceable.  
2.8            This release is a contract with legal and binding consequences and it applies to all races and activities entered at the event, regardless whether or not listed above.  
3.              Consent to treatment  
3.1           I agree that if I suffer injury the releasees' may at my expense arrange for me to receive medical treatment and emergency evacuation services as the releasees' deem appropriate and I understand that any personal injury that I incur may be worsened or compounded by not only my actions but by the actions, omissions or negligence of others.   3.2            I  agree that I  am  responsible for  my own medical and  ambulance insurance as  well as insurance for my personal belongings.  
4.              Release and Discharge      
I hereby unconditionally release and forever discharge from all liability the organizer of this event, the Namibian Cycling Federation, and their respective agents, insurers, employees, volunteers, members, clubs, officials, sponsors, event directors, local associations, and affiliates (collectively "releasees"), from any and all claims, suits, demands, expenses, costs, damages or proceedings of any nature whatsoever arising and resulting from any personal injury, death, property damage or loss sustained by me as a result of my participation in the event and I hereby agree not to take legal action of any kind against the organizer in connection with the event or my participation in it.  
5.              Indemnity      
5.1            I hereby unconditionally indemnify and hold harmless, and shall keep indemnified and held harmless, and promise not to sue, the releasees and all sponsors, organizers and promoting organizations, property owners, law enforcement agencies, public entities, local authorities, property owners that are in any manner connected with this event, and their respective agents, officials, and employees through or by which the event will be held, (the foregoing are also collectively deemed to be releasees), from any and all rights and claims including claims arising from the releasees' own negligence to the maximum extent permitted by law, which I have or which may hereafter accrue to me and from any and all damages which may be  sustained  by  me  directly  or  indirectly  in  connection  with,  or  arising  out  of,  my participation in or association with the event, or travel to or return from the event.  
5.2           I hereby unconditionally indemnify and hold harmless, and shall keep indemnified and held harmless the releasees and all sponsors, organizers and promoting organizations, property owners, law enforcement agencies, public entities, local authorities, and properties owners that are in any manner connected with this event, as a result of, or arising out of, whether directly or indirectly, my arrival and departure there from, attendance at registration, prize- giving or other function thereof, any loss or damage to bicycles or other equipment, however such loss or damage may arise regardless of whether or not the same shall have b een caused directly or indirectly by the negligence, albeit gross, of one or more of all the aforementioned parties as set out.  

6.              Medical Information      
I consent to the release by any third party to releasees and their insurance carriers of my name and medical information that may relate solely to any injury or death I may suffer arising from the event.  

7.              Photographic Material 
7.1           I hereby grant permission to the rights of my image, likeness and sound of my voice as recorded on audio, video or photograph without payment or any other consideration.  I understand that my image may be edited, copied, exhibited, published or distributed and waive the right to inspect or approve the finished product wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of my image or recording. I also understand that this material may be used in within an unrestricted geographic area.    
7.2          By signing this release, I understand this permission signifies that photographic or video recordings of me may be electronically displayed via the Internet or in a public setting.     
7.3          There is no time limit on the validity of this release nor is there any geographic limitation on where these materials may be distributed.   7.4           This release applies to photographic, audio or video recordings collected as part of the event that I am entering.    
7.5           By signing this form I acknowledge that I have completely read and fully understand the above release and agree to be bound thereby. I hereby release any and all claims against any person or organization utilizing this material.   
8.              Minors    
I attest that I am twenty one (21) years of age or older (or that if I am younger, my parents or legal guardian have executed this waiver below), and that I am physically fit and sufficiently trained to participate in  all  activities associated with  the  program  or  events and  my  participation in  such program or events is voluntary.   
9.              Age Consent And Release Of Parent\Legal Guardian   
9.1          I am the parent or legal guardian of (child). My child is fit for the event, and I consent to my child's participation.    
9.2           I have read and I understand the above contract.      
9.3           In consideration of allowing my child to participate, I consent to the contract and agree that it’s terms shall likewise bind me, my child, and our heirs, legal representatives, and assignees. I  hereby release and shall defend, indemnify and hold harmless the releasees from every claim  and  any  liability  that  I  or  my  child  may  allege  against  the  releasees  (including reasonable legal fees and costs) as a direct or indirect result of injury or death to me or my child or loss or damage to my or my child's property because of my child's participation in the event, whether caused by the negligence of the releasees or others to the maximum extent permitted by law.   
9.4           I promise not to sue releasees on my behalf or on behalf of my child regarding any claim arising from my child's participation in the event.

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Do you have medical aid and if so please provide the company and medical aid number?
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Medication for high blood pressure , cholesterol, diabetes or any other medication including herbal preparations and anti-coagulents.
{{'VALUE_SHORTER_THAN' | translate:'{char: "10000"}' }}
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If you have not yet registered for your NamCF nr, please register now @ www.mynamcycling.com.
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Please enter your ID nr if you do not have a NamCF nr.
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