TREE CLIMBERS MALAYSIA

Malaysia Tree Climbing Championships

rd
th
3 to 5 April 2015
Climber Entry Form and Waiver

This MUST be completed and submitted with your payment before 28th March 2015.
Applications to Tree Climbers Malaysia, Email: treeclimbersm@gmail.com or by Post: H-04-02 Jalan CU/A1 Taman
Cheras Utama, 56000 Cheras, Kuala Lumpur MALAYSIA.
Name
Date of Birth
Organisation
Emergency
Contact

Name:

Address:

PH:

Country
State

Post Code

Postal Address
Telephone

Mobile

( )

E-mail
Entry Fee

Malaysia Tree Climbing Championship

Side Event: Climbing Big Tree & Melaka Historical Trips

Shirt size:

Association name and Membership number (if applicable)

Method of Payment:

TREE CLIMBERS MALAYSIA (TCM)

Cheque (Bank cheque/money order)

Online payment: via Maybank2u.com.my
Cash (Make payment on event day)
Make payment to Xtree Resources. (Maybank:562106726334)

Please provide a brief description of competition experience, ranking and current employment.

RM250.00
RM180.00

TREE CLIMBERS MALAYSIA

MALAYSIA TREE CLIMBING CHAMPIONSHIPS (MTCC) 2015

RULES AND REGULATIONS

1.

By taking part in the MTCC, you undertake to obey the rules as set out herein and in paragraph 2 below (the Rules).

2.

The following Rules apply to all events in the MTCC 2014 and you shall comply with them:
(i)

(ii)

(iii)

(iv)

The competition rules of the International Tree Climbing Championships (English version, revised June 11
2014) by the International Society of Arboriculture. The complete sets of Rules are available at:http://www.itcc-isa.com/resources/rules_2014RuleBook_Final.pdf you will be deemed to have read and
familiarized yourself with the Rules and;
To be an eligible participant for Malaysia Tree Climbing Championships, you must be (a) a member of
Tree Climbers Malaysia (TCM) or; International Society of Arboriculture Society (ISA) and (b) must have
successfully completed WSQ Basic Tree Climbing Course or equivalent or must have competed
previously in a STCC or APTCC or any tree climbing competition.
Eligible competitors must complete and submit the official Climber Entry Form and Waiver to Tree Climbers
Malaysia (TCM) on or prior to the closing date as specified by the MTCC 2015 official organizer.
Eligible competitors must make full registration payment to Xtree Resources (Appointed company to
received all kind of payment or sponsorship for MTCC 2015) prior to the competition date as specified by the
MTCC 2015 official organizer

3.

The Tree Climbers Malaysia (the Organiser) reserve the right to amend the Rules at any time, or to implement any
other rules or instructions for the general safety of all participants.

4.

You understand and accept that participation in the MTCC 2015 may involve certain risks and dangers that may result
in serious injury, paralysis, disability or death and you hereby freely and voluntarily assume all risks and undertake
responsibility for your own health and safety during the MTCC 2015.

5.

You understand and agree that the Organiser and their employees or agents shall not be liable to you or anyone
entitled to claim through you for any injury (including death, paralysis or disability) or damage or loss of your property
sustained by you, in connection with or in the course of your participation in the MTCC 2015, and you hereby waive all
your rights against the Organizers.

6.

To participate in the MTCC 2015:(i)

You must comply with all the requirements in the competition rules of the International Tree Climbing
Championships (English version, revised June 11 2014) by the International Society of Arboriculture.

(ii)

be sufficiently physically fit to compete safely in this event and you must not have been advised otherwise by
a qualified doctor

(iii)

you must be appropriately attired and wear proper safety and protective gear during the event

(iv)

agree to the terms of and sign the Disclaimer and Indemnity Form, and;

(v)

Submit the Application Form together with payment, the Disclaimer and Indemnity Form and the Certification,
Waiver and Indemnity Form by Employer all duly completed and signed by the Registration closing date or
prior to the even as set out by the official organizers.

TREE CLIMBERS MALAYSIA

Disclaimer of Liability and Indemnity Form

1. I, ____________________ (name), having Passport number ________________,

2. I fully recognize and accept that any outdoor activities such as the events in the MTCC 2015 that involve substantial
and physically testing obstacles may involve certain dangers, including but not limited to the forces of nature,
unforeseeable failure of equipment and my own actions; and that participation in the MTCC 2015 may be dangerous
and involve risks and dangers that may result in serious injury, disability, paralysis or death to myself or other persons
participating in the MTCC 2015.
3. I declare that I am physically fit and I certify that to the best of my knowledge, I do not have a medical condition which
might have the effect of making it more likely that I will be involved in an incident which could result in injury to myself or
others.
4. I further declare that my participation in the MTCC 2015 is undertaken freely and voluntarily by me at my own risk. I
recognize and fully assume all risks and dangers involved in my participation and will not under any circumstances rely
on the care, judgment or assurance of anyone other than myself for matters relating to my own safety.
5. I agree that I am responsible for my own safety (and the safety of my possessions) and will not hold the Organiser
responsible for the consequences of my participation in the MTCC 2015, including any injury (including disability, death
or paralysis), damage to or loss of property sustained by me or for any loss, damage, expense or costs sustained by
me or arising out of my participation in the MTCC 2015.
6. In consideration of the Organisers acceptance of my application for entry as a participant in the MTCC 2015, I hereby
(i)

declare that I will not hold the Organiser or any of their employees or agents liable for any personal injury to
me (including disability, paralysis and death), or property loss or damage (including to my equipment);

(ii)

waive any and all claims I may have at any time, or any and all claims which might otherwise be made by, or
on behalf of, or on account of me, or by any person or entity in any way (whether under the right of
subrogation or otherwise), against the Organiser and their employees or agents, howsoever arising on
account of or in consequence of my activities or participation in the MTCC 2015, or in any other way related to
the MTCC 2015, whether arising in tort or contract; and

(iii)

undertake that I will, at all times sufficiently indemnify and keep the Organiser indemnified against any claim,
action, loss, costs and expense in respect of personal injuries sustained by me or damage to my property
caused by or arising from or in any way related to the MTCC 2015.

Participants Name and Signature

Date:

___________________________

_________________

MALAYSIA TREE CLIMBING CHAMPIONSHIPS (MTCC) 2015

DEED OF CERTIFICATION, WAIVER AND INDEMNITY BY EMPLOYER

TREE CLIMBERS MALAYSIA

Full Name of Employer:

Place of incorporation:
Mailing Address / Place of
Business:
Contact Telephone Number:
Facsimile Number:
Email Address:
1.

I, ___________________________ (name in full), declare that I am a representative of the Employer named above and
that I am duly authorised to sign and execute this Certification, Waiver and Indemnity Form for and on behalf of the
Employer, and that all necessary resolutions have been duly passed and adopted by the Employer.

2.

I certify that:
(i)
the Employer is aware of and agrees unconditionally to the Employee,
________________________________ (name in full), taking part in the Malaysia Tree Climbing Championship
2015 (MTCC 2015); and
(ii)
the Employer is also aware that the Employee is required to and has signed the Disclaimer of Liability and
Indemnity Form and has no objections thereto.

3.

The Employer hereby waives all and any subrogation rights or claims that the Employer may have against the Organiser
of the MTCC 2015, namely the Tree Climbers Malaysia and their employees, arising from any compensation or other
benefits or expenses incurred or paid by the Employer, its insurers or otherwise on its behalf, in the event of any claim or
injury to the Employee arising from the Employees participation in the MTCC 2015.

4.

The Employer agrees to indemnify and keep fully indemnified the Organiser of the MTCC 2015 from and against all
claims, demands, actions, suits, proceedings, liabilities of any kind, judgments, damages, costs, losses and expenses of
any nature whatsoever which the Employer may suffer or incur in connection with the loss of life, personal injury
(including disability or paralysis) and/or damage to property arising from or out of the Employees participation in the
MTCC 2015.

_______________________________________
Name/Signature of duly authorised representative

Date: _________________________

Employers stamp/chop