Entry and Sponsor Form

Entry Fee* £20*With

minimum of £30

sponsorship

One Mile

Sea Swim Broadsands, Paignton 21 September 2014

devonairambulancetrust @DevonAirAmb Registered Charity No: 1077998

TorbaySLFC @surflifesaving Registered Charity No: 101566

This event is organised by the Devon Air Ambulance Trust (‘DAAT’), whose registered office is at 5 Sandpiper Court, Harrington Lane, Exeter, EX4 8NS.

Thereby DAAT above shall be known as ‘the organiser’.

By entering the swim you agree to abide by the Conditions of Entry and any race instructions given to you by the organisers and officials of Agatha Christie Sea Swim.

SwimProficiency

By entering the Agatha Christie Sea Swim, I hereby declare that I will undertake adequate swim training to enable myself to complete a one mile swim unaided and that I am a competent swimmer.

MedicalConditions

It is strongly recommended that you train for the swim and prepare for the challenge. If you have not exercised before or for some time, consult your doctor for a check up.

RaceEjection

The event organiser reserves the right to refuse an entrant’s attendance at, and/or participation in, any of its events and/or a training swim if applicable. No dogs or other animals are allowed to swim in the event. We are continuing in our mission to organise the world’s best, safest and most enjoyable swimming event and hope you will help us in achieving this. Any participant who is found in breach of these terms and conditions will be excluded from future events. Please do not put someone else at risk.

Change of Address

If your address details change after you have submitted your application, please email us with details of your old and new addresses and date of birth at info@daat.org

For Reasons of Safety

No fancy dress will be permitted.

DataProtection

The organiser complies with the Data Protection Act 1998 and you have the right of access to your personal records held on our computer. Your name will be added to our mailing list so that we can keep you informed about the charity and also other events which you may be interested in. This information will not be passed on to any third party. You are entitled to withdraw your consent to this process by ticking the appropriate box on the sponsorship form.

Swim Hats

For safety reasons and primarily for the identification by medical staff, we strictly prohibit the swapping, sale, re-sale or transfer of the swim hats. Your issued swim hat must be visible at all times.

Swim Mementos

Only finishers will receive a commemorative medal. Non-participants are NOT eligible for event mementos. The event organiser reserves the right to change the style, size and type of event mementos offered to finishers.

CollectionandUseofInformation

You acknowledge and agree that your personal information (including medical information collected by event medical staff during or after the event) can be stored, used and disclosed by the event organiser in connection with the organisation, staging, promotion and administration of the event and for the compilation of statistical information.

UseofImages

By entering the race you give permission to the free use of your name, voice or picture to any broadcast, telecast, advertising, promotion or other medium at the Agatha Christie Sea Swim to the Organiser.

Water Temperature and Wetsuits

If the water temperature falls below 15oC on the day of the event, wetsuits will be compulsory and no swimmer will be allowed in the water without a wetsuit. We recommend wearing a swim specific wetsuit, ie those suits designed for triathlons, which will provide extra buoyancy and warmth.

Age Limits

All participants in the Agatha Christie Sea Swim must be 16 years of age or over on 15th September 2013. Entries for those aged 16-18 on the day of the swim must have their entries countersigned by a parent/guardian.

Entry Fees

Entry fees are £20 plus a minimum of £30 sponsorship for all UK residents. Applications will be accepted up to 9th September 2013. Entries will not be accepted after the closing date.

SwimCancellation

If the event is unable to take place due to unforeseen circumstances, the organiser will be entitled to cancel the event. In such circumstances, we will try to let you know in writing of the cancellation. In the event of cancellation your entry fee and sponsorship received via any online giving site is non refundable and the event organiser will accept no other liability to you for any costs or expenses you may incur as a result of that cancellation. In the event of a delay in the event which is due to unforeseen circumstances beyond our reasonable control, we will have no liability to you for any costs or expenses you may incur, although you may opt to cancel your place and in that case your entry fee and sponsorship as mentioned above is non refundable. Announcements of any cancellation/postponement will be via email, on Devon Air Ambulance Trust website and via local radio. Please ensure you enter a valid email address on your entry form.

TERMSanDConDITIonSoFEnTRy

Title (e.g. Mr, Mrs, Ms etc): First name:

Surname:

Address:

Postcode:

Telephone: Mobile:

Email:

Date of Birth: Gender: Male Female

Age on day of swim (please tick) 19 – 25 26 – 35 36 – 44 45 & over

16 – 18 (Age limit entrants must be 16 or over on 21 September 2014

Entry forms for those aged 16 - 18 on the day must be countersigned by

a parent/guardian by way of consent)

How did you hear about this event?:

EventSpecifics

How long do you consider it will take you to swim one mile? (Tick one box only)

under 40mins 50mins 60mins

80mins Over 80mins (maximum time limit 1hour 45mins)

If you would like to swim with a friend or family member who is also entering the swim, please state their name(s)

Name: Name:

We will endeavour to allocate you your preferred time, although this will be determined by your individual

estimated time taken to swim one mile

Do you consider yourself to be a competent swimmer? Yes No

Medical conditions (Please state):

Current medication (Please state):

On the day emergency contact details:

Contact name: Relationship to you:

Home telephone: Mobile:

EnTRyFoRM

Personal Details

I enclose a cheque for £20 per swimmer (tick box):

Please make cheques payable to ‘Devon Air Ambulance Trust’.

I’d like to pay my entry of £20 by credit/debit card (tick box): (Please complete details below)

Visa Maestro Mastercard Issue No (If applicable)

Card number:

Start date: Expiry date: Security Code: (Last digits on back of card)

BysigningthisformIconfirmthatIhavereadandacceptthetermsofentryassetoutinthisentryform.

Signed: Print name:

Date:

Ifyouarebetween16and18yearsold,pleaseaskyourparent/guardiantocountersignyourformbelow:

Signed (by parent or guardian): Print name:

Date:

If you would prefer to pay your £30 sponsorship monies yourself please tick here

I’d like to pay my sponsorship of £30 by credit/debit card (tick box):

please debit £50 from my card (including my £20 entry fee)

Your entry fee includes a days membership to the Torbay Surf Life Saving Club, to cover you for insurance purposes on the day of the Swim.

Proceeds will be shared between Devon Air Ambulance Trust and Torbay Surf Life Savers Clubs equally.

HoWToPay

Payment Details

Become a member of Torbay Surf Life Saving Club which includes annual membership toSurfLifeSavingGBandgetthecostofyourinsuranceforagathaChristieSwimdiscountedfromyouannualsubscription.FormoreinformationonclubmembershipbenefitsspeaktoamemberofTSLSCattheagathaChristieswim,pickupamembershipformorcheckusoutonFacebook/twitter.

Title (e.g. Mr, Mrs, Ms etc):

First name: Surname:

Address:

Postcode:

Telephone: Email:

noteforparticipants We never give your information to other organisations for marketing purposes. Your details will be used by DAAT and TSLSC. We would only give your data to another organisation if required to do so by law. We would like to send you news and information about DAAT and TSLSC and other ways to support us.

If you do not wish to receive this information, please tick this box

If you would like to set up an online sponsor page please log onto www.justgiving.co.uk and search ‘Devon Air Ambulance Trust’ following the instructions on screen to set up your page/account.

Note for sponsors If the named participant does not take part, any sponsor monies handed over to DAAT and TSLSC will be deemed as a donation to the charity.

Please tick the Gift Aid box if you would like DAAT and TSLSC to claim tax on your sponsorship donation; this will add to the value of the amount you donate without it costing you any extra. For example, at a basic rate of 20% DAAT and TSCSL would receive 25p extra for every pound you donate. To qualify for Gift Aid, what you pay in income/capital gains tax must be at least equal to the amount we claim on your donation in the tax year.

It is a requirement for you to use your home address and postcode to enable us to make the claim. We never give your information to other organisations. Your contact details will not be used by DAAT and TSLSC or passed to any other companies; details will only be used to reclaim Gift Aid on your donation where applicable. We are unable to claim Gift Aid on any sponsorship where a company address is provided.

aGaTHaCHRISTIEonEMILESEaSWIMSPonSoRFoRM

Name(Please use capital letters)

Home address(Please use capital letters and provide

your home address;DAAT and TSCSL will not use your

personal details to contact you in any way)

Postcode(Your postcode

must be suppliedin order for us toclaim Gift Aid foryour donation)

GiftAid(4)

Amountpledged

Amountcollected

MR A N OTHER 1HIGHSTREET,anyToWn,CoUnTy AB1 SFD 4 £10 £10

Sub Total

Name(Please use capital letters)

Home address(Please use capital letters and provide

your home address;DAAT and TSCSL will not use your

personal details to contact you in any way)

Postcode(Your postcode

must be suppliedin order for us toclaim Gift Aid foryour donation)

GiftAid(4)

Amountpledged

Amountcollected

MR A N OTHER 1HIGHSTREET,anyToWn,CoUnTy AB1 SFD 4 £10 £10

Sub Total

• youmustnotconsiderGiftaidascontributingtowardsyoursponsorshiptarget,butseeitasanadditiontoyourtarget.

• Please return all sponsorship forms with your minimum £30 sponsorship money to the address below or ontheday.Ifyoursponsorshipmoneyhasbeenraisedviajustgivingthenpleasebringalongascreenprintofyoursponsorshippage.

• ThissponsorshipformmustbereturnedtoDaaTtogetherwithalldonations.yourdonationsmustmatchthetotalonthissponsorshipform.

• allchequesmustbemadepayableto‘DevonairambulanceTrust’*.

Thankyou* All monies will be equally shared between DAAT and TSLSC

Devon Air Ambulance Trust, 5 Sandpiper Court, Harrington Lane, Exeter, EX4 8NS

aGaTHaCHRISTIEonEMILESEaSWIMSPonSoRFoRM ConT.