ʻrescue india 2018ʼ
RASHTRIYA LIFE SAVING SOCIETY (INDIA) NATIONAL HEADQUARTERS, PUNE
B4/101, Lunkad Daffodils,Viman Nagar, Pune. Pin: 411014 Tel. no.: 020 65600575
‘RESCUE INDIA 2018’ NATIONAL LIFESAVING SPORTS POOL CHAMPIONSHIP Venue: IIM Indore Sports Complex, Indore, Madhya Pradesh, India
Please attach ID size photo with full name written behind
REGISTRATION FORM-PARTICIPANT
Open for all Swimmers-Lifeguard certification NOT mandatory (all pages must be duly filled) Name & Contact of Team Manager*: ________________________ Name Mr. / Ms. _______________________________________________________________________________________________________________ Date of Birth: ________/__________/_____________________Age Group: ______________________________ M/F________________________ Representing State:____________________________________________ City:__________________________________________________________ Phone No(s): __________________________ Mobile No: _____________________________ Emergency No.: ____________________________ E Mail ID: ______________________________________________________________________________________________________________________ Organization/ Club / Team Name: ____________________________________________________________________________________________ Mailing Address of the Individual: ____________________________________________________________________________________________ ________________________________________________________________________________________________________________________________ Mailing Address of the Organization/Club: ___________________________________________________________________________________ ________________________________________________________________________________________________________________________________ Enter Codes of Individual Events (See code of Event List):*[Not required for Coach/Manager] __________/ __________/ __________/__________/ __________/ __________/ __________/ __________/ __________/ __________/ __________/__________/ __________/ __________/ __________/ __________/ Tick if applicable 1. Life Saver
2.Life Guard
3.Swimmer
4. Coach/ Team Manager
RLSS (I) Membership No*: ________________________Valid till *:_______________________________________ Total no of events: ____________________ Signature of competitor ____________________________________ Stamp & Sign of Club / Organization / SLTC / District: _______________________________________________________________________ Fee confirmation (please tick)-Event Announcement Registration fee
(Pool Events-Rs.800/-)
Lodging fee (@Rs.300/- per day) Food (@Rs.150/- per day) Total Amount Sent: Rs. ___________________________________ Deposit/Transfer via: (Chq/Bank)-_____________________ Bank Details:_____________________________________________
Online Registrations with Fee ONLY ON:
www.swimindia.in OFFLINE REG FOR LOCAL: Cheque/demand draft in favor of
Rashtriya Life Saving Society (I)-Rescue India 2016 OR Bank Transfer to (Beneficiary Name : “Rashtriya Life Saving Society (I)-Rescue India 2016”, Bank Name : The Catholic & Syrian Bank Limited, Address : 26/4, Matchwell Factory Road, Ramwadi, Pune 411014., IFSC Code : CSBK0000282, Swift Code : CSYBIN55), Account Number 028203669059190001
RASHTRIYA LIFE SAVING SOCIETY (INDIA) NATIONAL HEADQUARTERS, PUNE
B4/101, Lunkad Daffodils,Viman Nagar, Pune. Pin: 411014 Tel. no.: 020 65600575
EVENT CODES & DETAILS
AGE GROUPS FOR RI 2018 EVENTS: As on date of event
U- 12 (8yrs to 12yrs old) BOYS & GIRLS U-14 (12yrs+ to 14yrs old) BOYS & GIRLS U-16 (14yrs+ to 16yrs old) BOYS & GIRLS OPEN (16yrs+ to 25yrs old) BOYS & GIRLS MASTERS (25yrs+) 25yrs above Men & Women *Lifeguards(LG) (Selected events for valid & certified lifeguards only)
*LG (lifeguards) cannot compete in any other category if they chose to compete in LG category. ** Relay team events will be allowed for same state athletes and respective category.
Pool Events Code Events P1 50 mtrs Manikin carry (half fill) P2* 50 mtrs Manikin carry P3 100 mtrs Manikin carry with fins (half fill) P4* 100 mtrs Manikin carry with fins P5 100 mtrs Rescue medley P6 50 mtrs. Manikin tow with fins P7* 100 mtrs. Manikin tow with fins P8 50 mtrs, Obstacle swim P9 100 mtrs Obstacle swim P10 200 mtrs Obstacle swim P11* 200 mtrs Super lifesaver P12 10 mtrs. Line Throw (4 teams per state) P13 12 mtrs. Line Throw(4 teams per state) P14 4x25 Manikin carry relay P15 4x50 Obstacle relay P16 4x50 Medley relay P17* SERC (1 team per state) *applicable to Lifeguards (LG) also.
Age Groups U -12, 14 U -16, open, masters, LG U -12,14 U -16, open, LG U -16, open, masters U -12,14 U -16, open, masters, LG U -12 U -14, open, masters, LG U -16, open, masters U –14,16, open, masters,LG U –12,14 U -16, open, masters, LG U -12,14,16, open, masters U -12,14,16, open, masters U -12,14,16, open, masters Open , Masters & LG
Gender M/F M/F M/F M/F M/F M/F M/F M/F M/F M/F M/F M/F M/F M/F M/F M/F Mix
** All swimmers participating for the first time in Rescue India are required to attend the 1 day Lifesaving Sport training camp at Emerald International School, Indore, MP on the 3rd of June 2018 from 9am. INFORMATION CONTACT: Ph: +91 9112217605, +91 9975725432
RASHTRIYA LIFE SAVING SOCIETY (INDIA) NATIONAL HEADQUARTERS, PUNE
B4/101, Lunkad Daffodils,Viman Nagar, Pune. Pin: 411014 Tel. no.: 020 65600575
CONFIRMATION OF DATE OF BIRTH This is to certify that Master / Miss _________________________________________is a bonafide student of our school/college/institution, studying in ___________/
/
Date :
. His/Her date of Birth as per our records is
_________. ______________________________________________ (Name, Signature of principal and Seal of the Institution.)
Important Note: Participants must carry their proof of age.
_______________________________________________________________________________________
MEDICAL CERTIFICATE This is to certify that I have examined Master / Miss. / Mr. / Mrs._______________________________and hereby confirm that he/ she is mentally and physically fit to participate in swimming, lifesaving sports, beach & ocean events conducted by Rashtriya Life Saving Society (India).
Date :
.
_______________________________________ (Doctor’s Name, Signature, Stamp &Regn. No.) __
*INDEMINITY BOND I Master / Miss. / Mr. / Mrs. _______________________________________________________________ will be participating in the Rescue India 2018 event being organized by Rashtriya Life Saving Society (India) under aegis of International Life Saving Federation at IIM Indore, Madhya Pradesh, India from 3rd June, 2018 on Sunday to 5th June, 2018. I hereby state / declare that I am participating in this event at my own risk and consequences and therefore I will not hold anyone else (Organization, Institution or Individuals) responsible in any manner, in case of an injury, accident including temporary / permanent disablement or loss of life which may occur during or after the above event.
Date: Witness Signature Full Name Address Contact No.
______ _________ Parent Signature in case of minor
___ ___________ Competitor’s Signature
Witness Signature Full Name Address_______________ Contact No.
_________ ________ ___________ ____ ___________ ___________
**if you have not filled the above (Age declaration/ Medical form), participants must carry proof of age while reporting at the event.
RASHTRIYA LIFE SAVING SOCIETY (INDIA) NATIONAL HEADQUARTERS, PUNE
B4/101, Lunkad Daffodils,Viman Nagar, Pune. Pin: 411014 Tel. no.: 020 65600575
REGISTRATION INFORMATION & GUIDELINES 1.
Entry is open for all Swimmers-Lifeguard certification NOT mandatory.
2.
Entry eligibility will be limited to applicable age category ONLY. No cross category participation.
3.
Attach one photograph with your name written behind the picture.
4.
*You must also carry the original Lifesaving or LifeGuard Certificate & original Birth Certificate with you to be shown if challenged.
5.
Entry fees is Rs. 800/- per participant (Can participate in Pool Events). Entries/Registrations must reach before 26 May 2018.
6.
Participants must make their event registrations ONLINE ONLY on www.swimindia.in
7.
Cheque/Bank Transfer to (Beneficiary Name : “Rashtriya Life Saving Society (I)-Rescue India 2016”, Bank Name : The Catholic & Syrian Bank Limited, Address : 26/4, Matchwell Factory Road, Ramwadi, Pune 411014, IFSC Code : CSBK0000282, Swift Code : CSYBIN55), Account Number 028203669059190001
8.
All offline/local registrations must to be sent to: Debangshu Das/ Praphul Pandey, RESCUE INDIA 2018, Lifesaving Sports Coordinator, B/4 101, Lunkad Daffodils, Viman Nagar, Pune – 411014. Ph: +91 9112217605, +91 9975725432
9.
All email communications to- [email protected], [email protected]
10.
Registration once made cannot be cancelled. Entry Fees is non-refundable.
11.
Team Managers/Coaches are also to fill up attached Individual Entry Form with photograph.
12.
Individual & Consolidated entries must be sent through Courier or Speed Post ONLY.
13.
All participants must bring their own personal gears like costumes, cap, fins, goggles etc.
14.
Updates will be uploaded on www.lifesavingindia.com & www.swimindia.in
BEST WISHES RESCUE INDIA- Drowning Prevention & Community Building
B4/101, Lunkad Daffodils,Viman Nagar, Pune. Pin: 411014 Tel. no.: 020 65600575
‘RESCUE INDIA 2018’ NATIONAL LIFESAVING SPORTS POOL CHAMPIONSHIP Venue: IIM Indore Sports Complex, Indore, Madhya Pradesh, India
Please attach ID size photo with full name written behind
REGISTRATION FORM-PARTICIPANT
Open for all Swimmers-Lifeguard certification NOT mandatory (all pages must be duly filled) Name & Contact of Team Manager*: ________________________ Name Mr. / Ms. _______________________________________________________________________________________________________________ Date of Birth: ________/__________/_____________________Age Group: ______________________________ M/F________________________ Representing State:____________________________________________ City:__________________________________________________________ Phone No(s): __________________________ Mobile No: _____________________________ Emergency No.: ____________________________ E Mail ID: ______________________________________________________________________________________________________________________ Organization/ Club / Team Name: ____________________________________________________________________________________________ Mailing Address of the Individual: ____________________________________________________________________________________________ ________________________________________________________________________________________________________________________________ Mailing Address of the Organization/Club: ___________________________________________________________________________________ ________________________________________________________________________________________________________________________________ Enter Codes of Individual Events (See code of Event List):*[Not required for Coach/Manager] __________/ __________/ __________/__________/ __________/ __________/ __________/ __________/ __________/ __________/ __________/__________/ __________/ __________/ __________/ __________/ Tick if applicable 1. Life Saver
2.Life Guard
3.Swimmer
4. Coach/ Team Manager
RLSS (I) Membership No*: ________________________Valid till *:_______________________________________ Total no of events: ____________________ Signature of competitor ____________________________________ Stamp & Sign of Club / Organization / SLTC / District: _______________________________________________________________________ Fee confirmation (please tick)-Event Announcement Registration fee
(Pool Events-Rs.800/-)
Lodging fee (@Rs.300/- per day) Food (@Rs.150/- per day) Total Amount Sent: Rs. ___________________________________ Deposit/Transfer via: (Chq/Bank)-_____________________ Bank Details:_____________________________________________
Online Registrations with Fee ONLY ON:
www.swimindia.in OFFLINE REG FOR LOCAL: Cheque/demand draft in favor of
Rashtriya Life Saving Society (I)-Rescue India 2016 OR Bank Transfer to (Beneficiary Name : “Rashtriya Life Saving Society (I)-Rescue India 2016”, Bank Name : The Catholic & Syrian Bank Limited, Address : 26/4, Matchwell Factory Road, Ramwadi, Pune 411014., IFSC Code : CSBK0000282, Swift Code : CSYBIN55), Account Number 028203669059190001
RASHTRIYA LIFE SAVING SOCIETY (INDIA) NATIONAL HEADQUARTERS, PUNE
B4/101, Lunkad Daffodils,Viman Nagar, Pune. Pin: 411014 Tel. no.: 020 65600575
EVENT CODES & DETAILS
AGE GROUPS FOR RI 2018 EVENTS: As on date of event
U- 12 (8yrs to 12yrs old) BOYS & GIRLS U-14 (12yrs+ to 14yrs old) BOYS & GIRLS U-16 (14yrs+ to 16yrs old) BOYS & GIRLS OPEN (16yrs+ to 25yrs old) BOYS & GIRLS MASTERS (25yrs+) 25yrs above Men & Women *Lifeguards(LG) (Selected events for valid & certified lifeguards only)
*LG (lifeguards) cannot compete in any other category if they chose to compete in LG category. ** Relay team events will be allowed for same state athletes and respective category.
Pool Events Code Events P1 50 mtrs Manikin carry (half fill) P2* 50 mtrs Manikin carry P3 100 mtrs Manikin carry with fins (half fill) P4* 100 mtrs Manikin carry with fins P5 100 mtrs Rescue medley P6 50 mtrs. Manikin tow with fins P7* 100 mtrs. Manikin tow with fins P8 50 mtrs, Obstacle swim P9 100 mtrs Obstacle swim P10 200 mtrs Obstacle swim P11* 200 mtrs Super lifesaver P12 10 mtrs. Line Throw (4 teams per state) P13 12 mtrs. Line Throw(4 teams per state) P14 4x25 Manikin carry relay P15 4x50 Obstacle relay P16 4x50 Medley relay P17* SERC (1 team per state) *applicable to Lifeguards (LG) also.
Age Groups U -12, 14 U -16, open, masters, LG U -12,14 U -16, open, LG U -16, open, masters U -12,14 U -16, open, masters, LG U -12 U -14, open, masters, LG U -16, open, masters U –14,16, open, masters,LG U –12,14 U -16, open, masters, LG U -12,14,16, open, masters U -12,14,16, open, masters U -12,14,16, open, masters Open , Masters & LG
Gender M/F M/F M/F M/F M/F M/F M/F M/F M/F M/F M/F M/F M/F M/F M/F M/F Mix
** All swimmers participating for the first time in Rescue India are required to attend the 1 day Lifesaving Sport training camp at Emerald International School, Indore, MP on the 3rd of June 2018 from 9am. INFORMATION CONTACT: Ph: +91 9112217605, +91 9975725432
RASHTRIYA LIFE SAVING SOCIETY (INDIA) NATIONAL HEADQUARTERS, PUNE
B4/101, Lunkad Daffodils,Viman Nagar, Pune. Pin: 411014 Tel. no.: 020 65600575
CONFIRMATION OF DATE OF BIRTH This is to certify that Master / Miss _________________________________________is a bonafide student of our school/college/institution, studying in ___________/
/
Date :
. His/Her date of Birth as per our records is
_________. ______________________________________________ (Name, Signature of principal and Seal of the Institution.)
Important Note: Participants must carry their proof of age.
_______________________________________________________________________________________
MEDICAL CERTIFICATE This is to certify that I have examined Master / Miss. / Mr. / Mrs._______________________________and hereby confirm that he/ she is mentally and physically fit to participate in swimming, lifesaving sports, beach & ocean events conducted by Rashtriya Life Saving Society (India).
Date :
.
_______________________________________ (Doctor’s Name, Signature, Stamp &Regn. No.) __
*INDEMINITY BOND I Master / Miss. / Mr. / Mrs. _______________________________________________________________ will be participating in the Rescue India 2018 event being organized by Rashtriya Life Saving Society (India) under aegis of International Life Saving Federation at IIM Indore, Madhya Pradesh, India from 3rd June, 2018 on Sunday to 5th June, 2018. I hereby state / declare that I am participating in this event at my own risk and consequences and therefore I will not hold anyone else (Organization, Institution or Individuals) responsible in any manner, in case of an injury, accident including temporary / permanent disablement or loss of life which may occur during or after the above event.
Date: Witness Signature Full Name Address Contact No.
______ _________ Parent Signature in case of minor
___ ___________ Competitor’s Signature
Witness Signature Full Name Address_______________ Contact No.
_________ ________ ___________ ____ ___________ ___________
**if you have not filled the above (Age declaration/ Medical form), participants must carry proof of age while reporting at the event.
RASHTRIYA LIFE SAVING SOCIETY (INDIA) NATIONAL HEADQUARTERS, PUNE
B4/101, Lunkad Daffodils,Viman Nagar, Pune. Pin: 411014 Tel. no.: 020 65600575
REGISTRATION INFORMATION & GUIDELINES 1.
Entry is open for all Swimmers-Lifeguard certification NOT mandatory.
2.
Entry eligibility will be limited to applicable age category ONLY. No cross category participation.
3.
Attach one photograph with your name written behind the picture.
4.
*You must also carry the original Lifesaving or LifeGuard Certificate & original Birth Certificate with you to be shown if challenged.
5.
Entry fees is Rs. 800/- per participant (Can participate in Pool Events). Entries/Registrations must reach before 26 May 2018.
6.
Participants must make their event registrations ONLINE ONLY on www.swimindia.in
7.
Cheque/Bank Transfer to (Beneficiary Name : “Rashtriya Life Saving Society (I)-Rescue India 2016”, Bank Name : The Catholic & Syrian Bank Limited, Address : 26/4, Matchwell Factory Road, Ramwadi, Pune 411014, IFSC Code : CSBK0000282, Swift Code : CSYBIN55), Account Number 028203669059190001
8.
All offline/local registrations must to be sent to: Debangshu Das/ Praphul Pandey, RESCUE INDIA 2018, Lifesaving Sports Coordinator, B/4 101, Lunkad Daffodils, Viman Nagar, Pune – 411014. Ph: +91 9112217605, +91 9975725432
9.
All email communications to- [email protected], [email protected]
10.
Registration once made cannot be cancelled. Entry Fees is non-refundable.
11.
Team Managers/Coaches are also to fill up attached Individual Entry Form with photograph.
12.
Individual & Consolidated entries must be sent through Courier or Speed Post ONLY.
13.
All participants must bring their own personal gears like costumes, cap, fins, goggles etc.
14.
Updates will be uploaded on www.lifesavingindia.com & www.swimindia.in
BEST WISHES RESCUE INDIA- Drowning Prevention & Community Building
