Church Street Champions "*" indicates required fields Step 1 of 7 - Details 14% Contact DetailsName* First Last Email* Enter Email Confirm Email Phone*Address* Address Town Region Post Code How many children are you entering?*Please enter a number from 1 to 5. Child 1Name First Last CategoryGirls 8 - 10Boys 8 - 10Girls 11 - 13Boys 11 - 13Girls 14 - 16Boys 14 - 16Date of Birth Day Month Year Child 2Name First Last CategoryGirls 8 - 10Boys 8 - 10Girls 11 - 13Boys 11 - 13Girls 14 - 16Boys 14 - 16Date of Birth Day Month Year Child 3Name First Last CategoryGirls 8 - 10Boys 8 - 10Girls 11 - 13Boys 11 - 13Girls 14 - 16Boys 14 - 16Date of Birth Day Month Year Child 4Name First Last CategoryGirls 8 - 10Boys 8 - 10Girls 11 - 13Boys 11 - 13Girls 14 - 16Boys 14 - 16Date of Birth Day Month Year Child 5Name First Last CategoryGirls 8 - 10Boys 8 - 10Girls 11 - 13Boys 11 - 13Girls 14 - 16Boys 14 - 16Date of Birth Day Month Year By submitting this form Acknowledgment of Risk: I, the undersigned participant or parent/legal guardian of the participant, hereby acknowledge that my participation or my child's participation in the Church Street Champions involves physical activity, including but not limited to running, jumping, lifting weights, and other exercises. I understand that there are inherent risks associated with physical activity, including the risk of injury, illness, or death. Waiver and Release: In consideration of being permitted to participate in the Church Street Champions, I hereby waive, release, and discharge all claims, demands, and liabilities against Hauora Tinana Trust, its officers, directors, employees, volunteers, and agents from any and all injuries, damages, or losses that may arise directly or indirectly from my participation or my child's participation in the event. This includes, but is not limited to, any claims for personal injury, property damage, or wrongful death. Photography Release: I hereby grant permission to Hauora Tinana Trust to take photographs and/or videos of me or my child during the Church Street Champions and to use these materials for promotional purposes, including but not limited to social media, websites, and print materials. Consent* I agree I consent to my child/children entering the Church Street Champions Competition, I have read and understand the terms of the above waiver. NameThis field is for validation purposes and should be left unchanged.
