CLOSING DATE FOR ENTRIES20thSeptember 2017
SEND THIS FORM TO:
NATIONAL FEDERATION………………………………………
SWIMMER (Please print in English)
Family NameGiven NameGender
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Address
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HomeTownWeight (kg)Height (cm)
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Date of Birth (dd/mm/yyyy)OccupationSchool/University …. I will send photo by email
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NationalityPassport NumberEmail
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Club NameAccompanying Coach
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PERFORMANCES
Event NamePersonal Best Performances (time, year, place & competition)
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We verify that this participant is a member in good standing of a FINA affiliated Federation and he fully complies with the FINA Rules on sport nationality (FINA GR 2 ff):
DateNameof President or SecretarySignatureFederation Stamp
of Federation(Please print)
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Athlete Declaration: 1.FINA Rules, Regulations and Procedures I understand and accept that my participation at this event (“the EVENT”), which is part of the FINA Calendar is subject to my acceptance of all FINA Rules applicable in connection with such event. I therefore agree to be submitted to such rules, regulations, and procedures and to the juris-diction of the bodies which are in charge of applying them, including but not limited to the exclusive jurisdiction of the Court of Arbitration for Sport (CAS) in Lausanne, Switzerland, where such is provided by FINA Rules. 2.Doping Control Authorisation Upon request by FINA, or its authorised designees, I agree to submit to, and participate in, random drug testing at any time before, duringor after the EVENT and to fully comply with the FINA Doping Control Rules (FINA DC Rules) as well as the doping control procedures. 3.Transfer of Rights I hereby assign to FINA, with full title guarantee, for any and all territories in the world allpresent and future copyrights (including all rental and lending rights) in my per-formances and all other rights of whatsoever kind in respect of the EVENT, during the full period of copyright and thereafter (insofar as possible) in perpetuity and to sign anyother documents confirming such assignment as required by any relevant laws. I hereby waive all moral rights or rights of a similar nature to which I may be or become entitled to under the laws of any jurisdiction. I hereby grant to FINA all necessaryconsents and waivers under any relevant statute or other legislation that may create rights in my performances here-under to enable FINA to make the fullest use of my services hereunder in ways which may or may not be already contemplated. I further agree to be filmed, televised, photographed and otherwise recorded before, during and after the EVENT under the conditions and for the purposes specified by FINA. 4.Permission of Photo Use I agree that the Organising Committee may use my photo, provided as a part of my official entry, for the use on a EVENT Accreditation Card, as well as for an athlete profile to be offered to any person concerned with, or displayed during the EVENT. 5.Release I hereby declare that I exonerate FINA, the Host Member Federation, the FINA EVENT Organising Committee and their respective members, directors, officers, employees, volunteers, partners, contractors and agents as well as any other entities and persons involved with or participating in the EVENT from any liability with respect to all and any action, claims, losses, injuries, damages and costs incurred or suffered in relation to my participation in the EVENT. 6.Dispute Resolution I agree that any dispute which is not to be adjudicated in application of procedures provided for by the FINA Rules, but which arises between myself and FINA and/or the Host Member Federation and/or the FINA EVENT Organising Committee and/or their respective members, directors, officers, employees
and volunteers, including but not limited to claims for damages of either party against the other arising out of occurrences (acts or omissions) linked with my participation to the EVENT shall be governed by Swiss Law and exclusively settled by arbitration before the Court of Arbitration for Sport (CAS) in Lausanne, in accordance with the CAS rules then in effect. 7.Age If being under age on the first day of the EVENT, this is to certify that as parent/guardian of the listed athlete, I do hereby consent to his/her agreement to be bound by each of the terms and conditions identified above.
This Declaration shall be governed and construed according to Swiss Law and shall also be binding on my heirs, successors, beneficiaries, next of kin or assigns who might pursue any legal action in connection with the same.
I have read the entire Athlete Declaration form; I fully understand it and I agree to be legally bound by it:
DateAthlete or Parent/Guardian Signature
Name (print)
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Title Sponsor: