Enter Horison Adventure Dash 2019

Span naam *

Team Type *

Dropdown *

Only mixed teams qualify for prizes

Team Member 1 - Team Captain

Team Captain Name *

First

Last

Gender *

Male
Female

E-pos *

Cell Phone Number *

Ouderdom *

Geboortedatum *

Medical Conditions? Please List:

Medical conditions

Kontakpersoon in Geval van Nood *

First

Last

Kontaknommer in Geval van Nood *

Team Member 2

Gender *

Male
Female

Team Member 2 *

First

Last

E-pos *

Cell Phone Number *

Ouderdom *

Geboortedatum *

Medical Conditions? Please List:

Medical conditions

Emergency Contact Person (copy) *

First

Last

Emergency Contact Number (copy) *

Team Member 3

First

Last

Gender *

Male
Female

E-pos *

Cell Phone Number *

Ouderdom *

Geboortedatum *

Medical Conditions? Please List:

Kontakpersoon in Geval van Nood *

First

Last

Kontaknommer in Geval van Nood *

Team Member 4

Team Member 4 *

First

Last

Gender (copy) *

Male
Female

E-pos *

Cell Phone Number *

Ouderdom *

Geboortedatum *

Medical Conditions? Please List:

Kontakpersoon in Geval van Nood *

First

Last

Kontaknommer in Geval van Nood *

INDEMNITY *

I/we agree to enter and participate in the Horison Adventure Challenge entirely at my own risk and are fully aware of the risks and hazards involved in participating in this event. I/we indemnify the organisers, sponsors, land owners, Huis Horison and any person assisting in the organisation of the event against any and all liability whatsoever or claims of damages or actions whatsoever (including negligence) in any manner arising out of my/our participation in this event. I/we understand that I/we must be medically fit to take part in this race. I/we give consent to organisers to be photographed, which may be used for promotional purposes of any kind at any time in the future.

MINOR'S RELEASE

I, the minor's parent and/or legal guardian, understand tha nature of athletic activities and the minor's experience and capabilities and believe the minor to be qualified, in good health, and in proper phsical condition to participate in such activity and I enter into this indemnity/waiver on behalf of the minor. I agree that all minors under 14 years should be accompanied by an adult for the duration of the race.

Please Note. Entry is only complete once payment has been received.

Kindly make payment for the full amount to:
Huis Horison
Nedbank, Business Winelands
Tjekrekening
Rekening no: 1498044247
Takkode: 149821
Use your TEAM NAME + RACE as Reference

We will confirm your entry via email.

Look forward to seeing you there!

Inskrywingsvorm

Team Member 1 - Team Captain

Team Member 2

Team Member 3

Team Member 4

Nuttige Skakels

Registrasie besonderhede

Kontak Besonderhede

Adres