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Full Name:
Date of Birth:
ID Number:
Gender: Male || Female
Contact Number:
Emergency Contact:
School / Town:
Additional Queries:

In consideration of the acceptance of my entry I, for myself, executors, heirs, administrators and assigns, do hereby release and discharge Mountain Mill Mall, the Breedevallei Municipality and Worcester Gymnasium and all sponsors and voluntary groups, all medical personnel and official helpers from all claims for injuries, damage and property loss I may suffer, caused by negligence of any of them and arriving out of my participation in the event, including pre- and post-race activities. I am physically fit and sufficiently trained to participate in this event and assume all risks for participation. I accept all rules, conditions and regulations, which include terms of payment of the entry fees and will comply with them. I also grant my permission to the Mountain Mill Mall and Worcester Gymnasium to use my name, photographs, video tapes, broadcasts, telecasts, advertising, promotion or other account of this event, free of charge.

By submitting this entry form, I accept the terms and conditions, as set out above.

Closing date for entries

Pre-entries will close at 12 noon on 26 January 2018. Competitors are encouraged to enter online.
On race-day entries will close promptly 40 minutes before each race.

Entry fees:
3km: R120 Mile R80 (School teams of five or more pay only R50 per entry)
400m: R40 (School teams of five or more pay only R20 per entry)

Schools may contact mneethling@worcgim.co.za with enquiries.

Payment and Banking Details

Please ensure that your proof of payment is submitted along with your entry form. Entries without proof of payment will not be accepted.

Proof of payment can be faxed to: 023 3471129 or e-mailed to: mjonas@worcgim.co.za or ebarton@worcgim.co.za.

Account NameWorcester Gymnasium
Branch Code632005
Account No440153747
Reference on slip"Your name/MMM"


  • Entry forms are to be properly completed, giving ALL details.
  • If the swimmer is still in school, please ensure that have a signed copy of the entry form on the day of the event.
  • No swimmer under the age of 9, at the date of swim, will be allowed to compete.
  • Caps are to be worn for each event.
  • Wet suits are allowed, but no fins, flippers or other swimming aids.
  • Swimmers are required to attend an event briefing which is held 10 minutes prior to the event as details regarding route etc are advised at the briefing.
  • Swimmers must ALL follow the route and round course markers as instructed at the briefing.
  • Any swimmer not doing so will be disqualified.
  • Please note that only the first 10 places will be timed by us. Please arrange your own timing device or time keeper.
  • The names and times of the top 10 competitors in each category will be posted on Worcester Gymnasium’s website within 48 hours of the event.

Medals and Prizes

All mile and 3km competitors will receive a medal for participation.
Competitors will receive their medals at the end of the race.
Substantial cash prizes will be awarded to primary and high schools.
Gift vouchers will be awarded for 1st, 2nd & 3rd places in mile and 3km events.
There will be a number of lucky draws on the day.
The prize giving ceremony will start at 12:30 in the amphiteatre of the Mall.

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