(the Club)
Acknowledgment
of Risks and Obligations by Non-Members (Visitors)
I agree to participate in ..........................………………………… (the Activity)
Answer YES or NO
on ..….... / ..……./ 200….., an Activity of the Club.
I acknowledge that I am fully
aware that my involvement in this Activity may
expose me to risks and dangers such that I could suffer injury, illness or
death or
the loss of or damage to my property.
I warrant that this Activity is
within my capabilities, and I am carrying sufficient
food, water and equipment that is appropriate for the Activity.
I warrant that I have advised
the Activity leader of any medication that I am
taking or of any physical or other limitations that might affect my
participation in
the Activity; and I will abide by the Club's decision on my ability to
participate in
the Activity.
I will ensure that I make every
effort to remain with the rest of the party during
the Activity.
I acknowledge that as a Visitor
I am not covered by the Bushwalkers Public
Liability and Personal Accident Insurance Policies; and I acknowledge and
accept
that the Club is not in any manner whatsoever responsible for any injuries or
damage that I may suffer as a result of participating in the Activity.
I have read and I understand
these requirements.
Visitor's
Full Name
............................................…….……………………
Address ………………………………………………………
Phone
Contact …………………..
Signed .........................…………………….. Date
........ / …..... / ..….
Witness …………………………………… Date
…... / ……. / …...
If the Participant is under the Age of 18, a Parent or Guardian must also Sign & Date
this form. This signifies the Parent or Guardian has understood the Risks &
Obligations, and agrees to accept them.
Parent/Guardian Signature:…………...…………... Date: …../…../…..
Activity Leader is to post/hand this form to the Secretary as soon as possible after the Activity.