BIKE RALLY 27th February 2011 Registration Closes 13th February 2011 MY PARTICULARS (*Indicate when applicable) Declaration/Waiver Clause Health Declaration Form Name: _________________________________ Gender: ⎕ M ⎕ F I, ________________________________ (Name), ______________________ (NRIC No.) NRIC/Passport No.:_____________________________________ Please circle Yes or No for the following questions. consent to participate in Bike Rally 2011. I agree to hold NTU Sports Club Bike Rally 2011 Race: ⎕ Chinese ⎕ Indian ⎕ Malay ⎕ Others:_________________ committee and your organisers, sponsors, appointed officials or staff free of liability Date of birth :________________________________(DD/MM/YYYY) whatsoever for the loss of life or injury to person or loss or damage to property of goods 1) Do you have any heart conditions that allow you to perform physical activity only upon Address:____________________________________________________ whatsoever and howsoever occasioned during the Event. I further agree to keep the above mentioned indemnified form against all claims, actions, damage, losses and expenses recommendations by a doctor? _______________________________________S( ) (YES/NO) whatsoever and howsoever arising from the event. Contact:(H)____________________(HP)_________________________ 2) Do you feel any chest pain whenever you Email:____________________________________________________ I hereby certify that I will abide by the rules and regulations of Bike Rally 2011. I also declare perform physical activity? (YES/NO) NTU Student/Staff/Alumni: ⎕ Y ⎕ N (If yes, please refer to point 3.8 that I am medically fit and I take part in Bike Rally 2011 with full knowledge of the under Rules and Regulations) consequences that may arise from my participation in the event and do hereby, for myself, 3) Have you felt any chest pain in the past month? Even without performing physical activity? Student Matriculation No.(NTU):______________________________ my executors, administrators and assigns, covenant with the organisers and the sponsors to (YES/NO) Course & Graduation Year(NTU):______________________________ release them from any claims I may have against them in the event of an injury, fatal or 4) Have you ever lost consciousness, or lost balance Singlet Size: ⎕ S ⎕ M ⎕ L ⎕ XL otherwise, that I may suffer as a result of my participation. I also agree that the decision of due to dizziness, after strenuous activity? the Organising Committee is final and that no appeal will be entertained. Blood Group: ____________ Drug Allergies (if any):_______________ (YES/NO) Medical History (if any): _____________________________________ 5) Do you have a bone or joint condition that can be *Please note that participates aged 45 and above are advised to seek medical certification to Cycling Proficiency: ⎕ Beginner ⎕ Intermediate ⎕ Professional made worse by a change in your physical activity? ensure that they are fit for the event. (YES/NO) _________________________________ ________________________ 6) Are you currently on prescribed drugs for any NEXT OF KIN PARTICULARS heart condition or blood pressure? Signature of Participant Date Name:_____________________________________________ (YES/NO) Relationship:_________________________ 7) Are you aware if any physical condition that you INDEMNITY FORM may have, that may render you unsafe for Contact No. :(H)_______________________ strenuous activity? (HP)___________________________ (FOR PARTICIPANTS BELOW THE AGE OF 21) (YES/NO) I, ___________________________________________________ guardian of 8) Have you ever lost consciousness due to exercise, MISCELLANEOUS ______________________________________, whose particulars are as written above, emotions or startle? Registration Fees: ⎕ Public $26 confirm that I fully understand and appreciate the effect of the below Declaration Clause, (YES/NO) ⎕ NTU Student/Staff/Alumni $15 and hereby agree and declare on behalf of the Entrant that the purpose of the Declaration 9) Have you ever had unusual or extreme shortness Equipment Rental: ⎕ Bicycle $17 Clause will have equal binding effect on the Entrant, I will not hold NTU Sports Club of breath, during or after physical activity? ⎕ Helmet $3 responsible for any loss of life or injury to person or loss or damage to property of goods (YES/NO) whatsoever and howsoever occasioned at the Event. Limited Edition BR Jersey: ⎕ _____XS ⎕ ____S ⎕ ____M ⎕ ____L ** If your answer for any of the above questions is ⎕ ____XL ⎕ _____XXL 'yes', please obtain a certification of approval from a (Multiple orders are accepted, please indicate number of pieces beside certified doctor to prove that you are able to the checked box(es), the full-‐zip professional jerseys are $35 each. ___________________________________ ______________________ participate in strenuous activity, and submit it along Please take note of point 3.6 regarding the payment for the jerseys.) with the registration form for the organizers' NRIC / Passport No. & Date records. Signature of Parent/Guardian ⎕ One-‐way bus transport from NTU to the start point. (Only available for participants renting bicycles from NTU Sports Club. $2 transport fee to Rules and Regulations 2.6 Participants who pose a threat or safety hazard to the event will 3.9 New registration on the event day will not be entertained. be disqualified and the Organising Committee reserve the right 3.10 Please note that registration fee is NON-‐REFUNDABLE should (Please retain this section for own reference) to ensure that he/she will be unable to proceed with the event. the participant be unable to attend the event. 2.7 A minimum age of 16 is required of all participants. Section 4: Attire Section 1: General Rules 2.8 For all participants under age 21, a parent or legal guardian 4.1 For identification purposes, participants will be provided with 1.1 Bike Rally 2011 will be held on the 27th February 2011, and must agree to fill in a specific consent waiver, which can be an event singlet each that they will be required to wear the Organising Committee reserves the right to amend or found in the registration form. throughout the duration of the event. adjust the rules and regulations of the event, without prior 2.9 Only cycling is allowed during the event. Other activities, e.g. 4.2 Participants who are not in their event singlet will be required notification to the participant. rollerblading, are strictly prohibited and participants who insist to purchase one at $10 on the event day. 1.2 All participants are required to read, comprehend, on pursuing these activities will not be entertained and be 4.3 Participants are required to be in appropriate sports attire and understand and follow the stipulated rules and regulations, subsequently banned from participation. covered shoes all times during the event. Inappropriate event signs and directions, and verbal instructions given to footwear E.g. sandals and slippers will not be allowed. them during the course of the event. Section 3: Registration 4.4 No changes of sizes of singlets and finisher tees are allowed. 1.3 Participants are advised to check our website regularly for 3.1 Only the official registration forms or photocopied versions of We will adhere strictly to the size that participants indicated on any updates or amendments with regard to event the original copy will be accepted. the registration form. instructions and information E.g. reporting time/venue etc. 3.2 Closing date for the submission of registration forms will be on th This can be done by visiting our website the 13 February 2011. Late entries will not be entertained. Section 5: Equipment and Provision http://bikerally.ntusportsclub.sg 3.3 All registration forms should be submitted together with a 5.1 Participants can choose to bring their personal bicycles 1.4 The Organising Committee, NTU Sports Club, and related cheque payable to “NTU Student Union” and mailed to the or use the ones provided to them. However, sponsors, officials and other staff, will not be held following address: participants are strongly encouraged to use their own responsible for the cancellation of the event due to bicycles and those doing so are required to report at the unforeseen circumstances e.g. weather conditions etc. Bike Rally 2011 event venue together with their bicycle. 1.5 All participants are to attend the pre-‐event briefing/event-‐ NTU Sports Club 5.2 Participants who need to rent bicycles and safety pack collection. Participants will be informed of the exact c/o Sports and Recreation Centre helmets for the event will be charged accordingly. date closer to the event. 20 Nanyang Green 5.3 It is compulsory for safety helmets to be worn by all Singapore 637715 participants throughout the entire journey. Section 2: Participation 5.4 Participants are encouraged to bring along personal 2.1 Registration is on a first-‐come-‐first-‐serve basis, and is 3.4 Money orders and cash WILL NOT be accepted and NTU Sports items for their own well-‐being and comfort on the subjected to a maximum capacity. After which, subsequent Club will not be held responsible for the loss of these items. event day itself e.g. sun block, sunglasses, cap, seat 3.5 Please indicate the name, NRIC and contact number of the padding, gloves, water bottles etc. application will be rejected. individual participants at the back of the cheque. 2.2 Incomplete registration forms or those which contain 3.6 For the purchase of the full-‐zip professional jersey, please Section 6: Enquiries incorrect or fraudulent information will be deemed invalid include a separate cheque of $35 with your name, NRIC, 6.1 For general enquiries, please contact Chen Shao@ and rejected. contact number and jersey size written at the back. Please 91456373 2.3 Late comers will not be entertained on the event day itself. make it payable to CHEN RENFEI RAPHAEL. Should the limited 6.2 For registration enquiries, please contact XinRu @ 2.4 Upon registration, each participant must certify that he/she jerseys be sold out, we will dispose of your cheque accordingly. 93203309 or KaiLing @ 81025907 is physically fit to complete the event and is not suffering *For participants who have already registered, please mail in a 6.3 For additional information, participants may refer to the from any medical condition whatsoever, which would inhibit cheque of $35 with your name, NRIC and contact number FAQ section in the official event website at him/her from completing the event. Participants must also written at the back. http://bikerally.ntusportsclub.sg ensure that they possess reasonable sufficient cycling 3.7 All participants should receive a confirmation EMAIL/SMS abilities, which are adequate for them to complete the event verifying the successful transaction at least one week before If you have any other enquiries, feel free to email us at successfully and safely. the commencement of the event. Additional details can be email@example.com 2.5 Participants are required to adhere to safety traffic rules and found on our website. regulations at all times during the event. They are further 3.8 Participants under the ‘NTU Students/Staff/Alumni’ category required to follow instructions and cycle in a single file. are required to submit a photocopy of any form of NTU Overtaking of the lead cyclist is not allowed. identification (E.g. Matriculation/Student/Alumni Card), attached together with the registration form.