2008 Uapa Open
2009 CPU Western Canadian Powerlifting and Bench Press Championships
Hosted by the University of Alberta Powerlifting Association
IMPORTANT: By signing this document, you will waive certain legal rights, including the right to sue.
PLEASE READ CAREFULLY
UNIVERSITY OF ALBERTA STUDENTS’ UNION AND THE GOVERNORS OF THE UNIVERSITY OF ALBERTA
WAIVER OF LIABILITY AGREEMENT
NAME OF PARTICIPANT ____________________________ DATE OF BIRTH (dd/mm/year) ___________________________
DISCLAIMER CLAUSE
The University of Alberta Students’ Union and the Governors of the University of Alberta and their agents, officers, directors, officials,
employees, volunteers, members and representatives (hereafter called the “Students’ Union and the U of A”), are not responsible for
any injury, loss or damage of any kind which I might sustain practicing or performing the “Powerlifting” in the Universiade Pavilion, U of
A Campus for the duration of: Saturday, November 21, 2009. Including injury, loss or damage which might be caused by the
negligence of the Students’ Union and/or the U of A and/or the Organizing Committee.
DESCRIPTION OF RISKS
I acknowledge that I am aware of the possible RISKS, DANGERS AND HAZARDS associated with my/my child practicing and/or
performing the Powerlifting in the Universiade Pavilion, U of A Campus INCLUDING THE POSSIBLE RISK OF SEVERE OR FATAL
INJURY TO MYSELF OR OTHERS. These risks include, but are not limited to: muscular injuries, bruises, scrapes, cuts, sprains,
dislocations, broken bones and head, facial or dental injuries which might result from my/my child Powerlifting at the Universiade
Pavilion, U of A Campus.
INDEMNIFICATION AND RELEASE OF LIABILITY
In return for the Students’ Union and the Governors of the U of A allowing me/my child to practice and/or perform ‘Powerlifting’ at the
Universiade Pavilion, U of A Campus, I agree:
1) TO NOT CONSUME ANY TYPE OF ALCOHOL WITHIN TWELVE (12) HOURS PRIOR TO THE ‘POWERLIFTING
EVENT’ OR DURING THE ‘POWERLIFTING’ EVENT.
2) TO ASSUME AND ACCEPT ALL RISKS arising out of allowing me/my child to practice and/or perform ‘Powerlifting’ at the Universiade Pavilion, U of A
Campus even though such risks may have been caused by the negligence of the
Students’ Union and/or the U of A;
3) TO BE SOLELY RESPONSIBLE FOR AN INJURY, LOSS OR DAMAGE which I/my child might sustain while
practicing and/or performing ‘Powerlifting’ at the Universiade Pavilion, U of A Campus even though such injury, loss or
damage may have been caused by the negligence of the Students’ Union and/or the U of A;
4) TO HOLD HARMLESS AND INDEMNIFY THE STUDENTS’ UNION AND THE GOVERNORS OF THE U OF A from
any and all liability for any damage to the property of, or personal injury to, any third party, resulting from my/my child
practicing and/or performing ‘Powerlifting’ at the Universiade Pavilion, U of A Campus even though such injury, loss or
damage may have been caused by the negligence of the Students’ Union and/or the U of A;.
5) TO BE SOLELY RESPONSIBLE TO PROVIDE my/my child own medical/health care and insurance coverage in the
event of accident while practising and/or performing ‘Powerlifting’ at the Universiade Pavilion, U of A Campus even though such injury, loss or damage may have
been caused by the negligence of the Students’ Union and/or the U of A;.
6) TO INDEMNIFY AND HOLD HARMLESS THE STUDENTS’ UNION AND THE GOVERNORS OF THE U OF A, and
their agents, officers, directors, officials, employees, volunteers, members and representatives from any and all claims,
demands, actions and costs which might arise from my/my child practicing and/or performing ‘Powerlifting’ at the
Universiade Pavilion, U of A Campus even though such injury, loss or damage may have been caused by the negligence of the Students’ Union and/or the U of A.
ACKNOWLEDGMENT
I UNDERSTAND THAT THIS IS A LEGAL AGREEMENT. It is binding on me as well as on my heirs, executors and representatives,
in the event of my death or incapacity. I HAVE READ AND UNDERSTOOD ALL THE TERMS OF THIS AGREEMENT and by
signing this agreement voluntarily; I am agreeing to abide by these terms.
Signed this ____________ day of ____________________, 2009, at Edmonton, Alberta.
CONSENT: I consent for my child’s participation in the ’Powerlifting’ at the Universiade Pavilion, U of A Campus.
Date: Saturday, November 21, 2009
powerlifting meet before the bench only, we cannot
commit to a pre-determined timeline.
Awards:
Place: University of Alberta Pavilion (a.k.a. ‘The
To be determined by meet organizers.
Butterdome’,
Open To: Any lifters from Canada with a valid CPU
‘Building 81’; please refer to the map of the University
membership card and previous experience (within the
NOTE: Your placing in the competition has no bearing on
of Alberta Campus; note the location of the contest and
CPU). If you need a CPU membership card and you are
your eligibility to claim record lifts and/or totals.
the nearest parking locations). Edmonton, Alberta
an Alberta resident, visit the Alberta webpage (under
http://www.campusmap.ualberta.ca/index.cfm?campus=1
‘links’ @ www.powerlifting.ca)
Rules:
§or=4&feature=50
IPF/CPU rules will be in effect and enforced. Please be
Classes: Women: 48, 52, 56, 60, 67.5, 75, 82.5, 90, 90+
aware of the rules of performance and equipment
Full Powerlifting will take place before the
KG’s, If Sub Jr. – 44 kg also.
standards. The official rulebook can be found here:
Men: 56, 60, 67.5, 75, 82.5, 90, 100, 110, 125, 125+ KG’s,
http://www.powerlifting-ipf.com/ipf_technical_rulebook.htm
Bench Only Event.
If Sub Jr. – 52 kg also.
Meet Directors:
Time: Weigh In: 8 AM
The University of Alberta Powerlifting Association,
Divisions: Powerlifting and Bench Press
Executive Members.
Full Powerlifting Begins: 10 AM
Drug Testing:
To C.C.E.S. specifications. Lifters should be prepared to
Bench-Only Weigh In: 8 AM, UNLESS YOU PLAN TO
RECORDS
be drug tested in accordance with C.P.U./I.P.F. rules and
Sufficient referees will be on hand for those interested in
ATTEMPT A RECORD BENCH PRESS. If this is the case,
regulations. Any lifters setting National Records will be
attempting National records.
the weigh in will occur 2 hrs prior to the commencement of
required to pay a $75 Record Application Fee regardless
the bench only contest. Due to the nature of running a ful -
of whether or not a test is administered.
Entry Fees & Deadline:
Final deadline for entries is Friday, November 6, 2009.
Due to venue space and time limitations, only the first 42
Powerlifting, and the first 28 Bench Press entries received will be
accepted.
Please see the following page for fee details.
Phone-In Registration
Is available with a valid VISA or Mastercard number. Please cal
(780) 492-2231 between Mon.-Fri. 0900-1700hrs.
Fax Registration
Complete the registration with a valid VISA and Mastercard number
and fax completed for to (780) 492-7190.
Mail Entry Form:
Entry forms can also be sent to (see address on form below)
Cheques payable to: University of Alberta
Any NSF Cheques will be assessed any bank charges. No refunds
wil be issued.
University Maps Available at:
http://www.campusmap.ualberta.ca/building.cfm?id=50
Event participants requirement to sign a waiver for the
University of Alberta:
Each participant will be required to sign a release of liability, waiver of claims and indemnification agreement before they can participate in the event on Saturday, November
21, 2009. Waivers can be signed during the check-in on event day, or by submitting the waiver to the registration office prior to the meet. The waiver will wave the rights of the
participant to sue in the event of any/all injuries received during the event. The waiver must be signed prior to the start of the competition. Failure to agree and to sign this
document will bar you from participation in the event. Please DO NOT CONSUME any alcohol prior to coming to sign this document (you will not be allowed to sign the waiver
and therefore, can not participate).
___________________
Signature of Participant or Legal Guardian if participant under 18 years of age
___________________
Signature of Witness (with the Powerlifters)
___________________
Printed Name of Participant or Legal Guardian
___________________
Printed Name of Witness
Office Use Only:
Date received: ______________ Amount Received: ________________ Entered: ________________
U of A Powerlifting Association
And the
Alberta Powerlifting Union
Present the
2009 CPU Western Canadian Powerlifting and Bench Press
Championships
Saturday
November 21, 2009
Universiade Pavilion (Butterdome)
U of A Campus
Edmonton, AB
Sanctioned by
Canadian Powerlifting Union
UAPA Host the 2009 Western Canadian Powerlifting and Bench
Press Championships
Entry Form
Type of Entry:
Powerlifting only:
COURSE CODE: 13739
Bench only
COURSE CODE: 13740
Both (Powerlifting + Bench Press):
COURSE CODE: 13741
High School Single:
COURSE CODE: 13742
High School both:
COURSE CODE: 13743
Name: ________________________________________Weight Class: _________kg
CPU Membership #: _______
Address: __________________________ City: ___________________
Postal Code: _________________
Telephone: __________________
Gender: M or F E-mail: _______________________________
Date of Birth: __________________ Shirt Size: S M L XL XXL
:
Medical Conditions: __________________________
Emergency Contact: __________________________
(Name & Phone#)
Entry Fee & Deadline:
Entries will be accepted until Friday, November 6, 2009. The maximum number of entries accepted is 42
Powerlifting & 28 Bench Press.
***** NOTES:
1- PREVIOUS LIFTING EXPERIENCE IN THE C.P.U. IS A PRE-REQUISITE FOR THIS
COMPETITION
2- THESE ENTRY FEES INCLUDE A $20 CHARGE PER LIFTER TO BE USED FOR DRUG
TESTING PURPOSES BY THE C.P.U.
3- THESE ENTRY FEES INCLUDE APPLICABLE TAXES.
Individual Event:
Powerlifting Only $75.00
Bench Press Only $60.00
Register for Both Events: Powerlifting & Bench Press $100.00
High school (junior and senior) – single event: $30.00 both events: $40.00
Every participant will be required to present their CPU/APU membership card, or to purchase one beforehand or at
the meet site. If you need a CPU membership card and you are an Alberta resident, visit the Alberta webpage (under
‘links’ @ www.powerlifting.ca)
High School (junior and senior) students are required to do both of the following before participating:
1) purchase a CPU/APU membership card for $25 AND
2) present their school ID on the day of contest.
Meet T-Shirt: one additional shirt per entry form per lifter (additional T-Shirts, $20.00. Any T-shirts purchased the day
of the event will subject to availability.)
Additional T-Shirt: $20.00/shirt Shirt Size: S M L XL XXL
Total Amount Enclosed/Paid : $ _____________
Method of Payment: Cash Cheque
VISA Mastercard Debit (in person only)
Credit Card Number: ___________________________________________ Expiry Date (mm/yy)__________________
Name on Card if different from Above: ____________________________________________________________________
Signature: ___________________________________________________________________________________________
For registration: call 492-2231
or
Mail entry form to:
UofA Powerlifting Club
c/o Activity Registration Zone Sales Office
Rm. W-79, Van Vliet Centre
Faculty of Physical Education & Recreation
University of Alberta, Edmonton, AB T6G 2H9
