Avantiplus Cairns Pty Ltd as trustee for Avantiplus Cairns Trust PARTICIPANT'S ACKNOWLEDGEMENT OF RISK FORM INCLUDING WAIVER, RELEASE & INDEMNITY

Transcription

1 Avantiplus Cairns Pty Ltd as trustee for Avantiplus Cairns Trust PARTICIPANT'S ACKNOWLEDGEMENT OF RISK FORM INCLUDING WAIVER, RELEASE & INDEMNITY Activity: Weekly Shop Ride A group bicycle ride which is led by Avantiplus and departs from Avantiplus (105 Sheridan Street, Cairns) and navigates through all areas of Cairns and from Gordonvale to Palm Cove (referred to in this document as the Activity ) This is an important document which affects your legal rights and obligations. Read it carefully and do not sign it unless you are satisfied that you understand it. If you sign this document, you are taken to have read, understood and accepted the terms contained in the document. If you have any questions about the meaning or effect of this document you must ask an Avantiplus representative or obtain your own legal advice. PARTICIPANT S DETAILS: Full Name: Address: Phone Number: Next of Kin (full name and phone number): RISKS OF THE ACTIVITY: Minor physical injury to the Participant and other parties, including but not limited to muscular injury, skeletal injury, bruises, scrapes, abrasions, breaks, dislocations and mental or psychological harm Major (i.e. severe and/or fatal) physical injury to the Participant and other parties, including mental or psychological harm, paralysis and/or death Minor damage to the Participant s and other parties property Major damage to or loss or destruction of the Participant s and other parties property, arising as a result of or in connection with any of the following: The actions (including negligent actions) of the Participant and/or Avantiplus, its directors, officers, servants, employees, volunteers and agents, and/or third parties; The natural conditions, including the landscape and climate, in which the Activity is performed; The Participant s equipment/property, Avantiplus equipment/property (including that of its directors, officers, servants, employees, volunteers and agents, and/or third parties) or third parties equipment/property. MEDICAL DISCLOSURE: (The Participant must detail all of his/her medical or other conditions).... 1

2 This Agreement is entered into between Avantiplus Cairns Pty Ltd as trustee for Avantiplus Cairns Trust ( Avantiplus ) and the Participant. In consideration of being permitted by Avantiplus to participate in the Activity, including any related events and activities, the Participant agrees as follows: ACKNOWLEDGEMENT 1. I acknowledge that: (a) (b) (c) (d) (e) (f) (g) I am being supplied with a recreational service by Avantiplus. This Agreement applies to each and every occasion on which I participate in the Activity, unless Avantiplus and I reach another agreement which is recorded in writing and signed by both parties. The Activity is a dangerous recreational activity which involves significant risks of injury and damage, including the potential for permanent paralysis and/or death. The risks of the Activity are set out on page 1 of this agreement (under the heading Risks of the Activity ) and may also include other risks which are not set out in this Agreement. The natural conditions in which the Activity is performed may vary without warning. Avantiplus relies on the information provided by me in this document and I hereby state that all such information is accurate and complete. This document records the entire agreement between Avantiplus and me in relation to the Activity and my participation in it. If any term in this document is held to be void or unenforceable, it must be severed from the document and the terms that are not void or unenforceable will not be affected by the severance. RISK WARNING 2. I acknowledge that I have been warned of the Risks of the Activity. 3. I acknowledge that the Activity may involve risks which are not listed in the Risks of the Activity list on page 1. ASSUMPTION OF RISK 4. I knowingly, freely and voluntarily assume all of the Risks of the Activity, whether they are known or unknown to me at the time of signing this document. DRUGS AND/OR ALCOHOL 5. I am aware of the dangers associated with the consumption of alcohol, mind altering substance, drug or other substance which may impair my judgment or physical ability or capacity to safely participate in the Activity. 6. I warrant and certify that before and during the Activity, I will not consume any alcohol, mind altering substance, drug or other substance which may impair my judgement, physical ability or capacity to safely participate in the Activity. 7. I accept full responsibility for any injury, loss or damage associated with my consumption of alcohol, mind altering substance, drug or other substance which impairs my judgement, physical ability or capacity to safely participate in the Activity. 2

3 SAFETY 8. I agree that I am solely responsible for my own safety while I am participating in the Activity. 9. I agree that I will take all reasonable steps to ensure my own safety, including by wearing appropriate safety gear such as a helmet, and by keeping myself appropriately hydrated. MEDICAL CONDITION 10. I certify that I am physically fit and able to participate in the Activity and I have not been advised to not participate in the Activity by a qualified medical professional. 11. I warrant and certify that in this document I have disclosed any pre-existing medical or other conditions that may affect my ability or the ability of any other person to participate in the Activity. Apart from the conditions which I have disclosed in this document, there are no health related reasons or other problems which preclude my participation in the Activity. WAIVER, RELEASE AND INDEMNITY 12. To the extent permissible by law, I agree that the provisions of Schedule 2 The Australian Consumer Law of the Competition and Consumer Act 2010 (Cth) and any similar state legislative provisions (which provide for an implied warranty that services be rendered with due care and skill and that any material supplied in connection with those services will be reasonably fit for purpose) are expressly excluded and do not apply to this agreement. 13. I agree to release and hold harmless Avantiplus, its directors, officers, servants, employees, volunteers and agents from and against any liability arising out of any injury, loss, damage or death caused to me or my property or any other person arising from or in connection with my participation in the Activity, whether such injury, loss, damage or death was caused directly or indirectly by negligence, breach of contract or any way whatsoever other than where the injury, loss, damage or death was caused solely by the negligence of Avantiplus, its directors, officers, servants, employees, volunteers and agents. 14. I agree to indemnify and hold harmless Avantiplus, its directors, officers, servants, employees, volunteers and agents from all claims, damages, losses, injuries and expenses arising out of or resulting from my participation in the Activity. This indemnity extends to all claims made by any other person against Avantiplus, its directors, officers, servants, employees, volunteers and agents in respect of any injury, loss or damage arising out of or in connection with my participation in the Activity, other than where the injury, loss, damage or death was caused solely by the negligence of Avantiplus, its directors, officers, servants, employees, volunteers and agents. MISCELLANEOUS 15. I agree to comply with all rules and directions made or given by Avantiplus in connection with the Activity. I understand that if I fail to comply with any rules and/or directions of Avantiplus: (a) I may be injured or may injure someone else; and (b) I will not be permitted to continue the Activity and no refund will be given to me. 16. I agree to report all hazards, accidents, injuries, loss or damage sustained by me or any other person to Avantiplus immediately after I become aware of such hazards, accidents, injuries, loss or damage. 17. I agree that if I suffer any injury or illness while performing the Activity, Avantiplus may provide or arrange evacuation, first aid and medical treatment at my expense. I consent to receiving medical treatment in the event that I suffer any injury or illness while performing the Activity. 18. I understand that I may be photographed or videoed while participating in the Activity. I agree to allow any such photos or videos to be used for any purpose to be determined by Avantiplus in Avantiplus absolute discretion. 3

4 BY SIGNING THIS DOCUMENT, I EXPRESSLY ACKNOWLEDGE AND AGREE THAT: - I am over the age of 18 years old and I have mental capacity to sign this document - I have read this document and confirm that if I have been unsure about the term/s contained in it, I have advised an Avantiplus representative and the Avantiplus representative has explained the term/s to me - I fully understand the terms of this document - This document contains a release of liability and I have given up substantial legal rights by agreeing to the release of liability - I am participating in the Activity voluntarily, of my own free will and without any inducement, advice or representation being made to me by any person. - I have signed this document voluntarily, of my own free will and without any inducement, advice or representation being made to me by any person. Signature of participant Witness name Witness address Date Witness signature Date 4

5 Avantiplus Cairns Pty Ltd as trustee for Avantiplus Cairns Trust PARTICIPANT'S ACKNOWLEDGEMENT OF RISK FORM INCLUDING WAIVER, RELEASE & INDEMNITY Activity: Weekly Shop Ride A group bicycle ride which is led by Avantiplus and departs from Avantiplus (105 Sheridan Street, Cairns) and navigates through all areas of Cairns and from Gordonvale to Palm Cove (referred to in this document as the Activity ) This is an important document which affects your legal rights and obligations. Read it carefully and do not sign it unless you are satisfied that you understand it. If you sign this document, you are taken to have read, understood and accepted the terms contained in the document. If you have any questions about the meaning or effect of this document you must ask an Avantiplus representative or obtain your own legal advice. PARTICIPANT S DETAILS: Full Name: Address: Phone Number: Next of Kin (full name and phone number): RISKS OF THE ACTIVITY: Minor physical injury to the Participant and other parties, including but not limited to muscular injury, skeletal injury, bruises, scrapes, abrasions, breaks, dislocations and mental or psychological harm Major (i.e. severe and/or fatal) physical injury to the Participant and other parties, including mental or psychological harm, paralysis and/or death Minor damage to the Participant s and other parties property Major damage to or loss or destruction of the Participant s and other parties property, arising as a result of or in connection with any of the following: The actions (including negligent actions) of the Participant and/or Avantiplus, its directors, officers, servants, employees, volunteers and agents, and/or third parties; The natural conditions, including the landscape and climate, in which the Activity is performed; The Participant s equipment/property, Avantiplus equipment/property (including that of its directors, officers, servants, employees, volunteers and agents, and/or third parties) or third parties equipment/property. MEDICAL DISCLOSURE: (The Participant must detail all of his/her medical or other conditions).... 1

6 This Agreement is entered into between Avantiplus Cairns Pty Ltd as trustee for Avantiplus Cairns Trust ( Avantiplus ) and the Participant. In consideration of being permitted by Avantiplus to participate in the Activity, including any related events and activities, the Participant agrees as follows: ACKNOWLEDGEMENT 1. I acknowledge that: (a) (b) (c) (d) (e) (f) (g) I am being supplied with a recreational service by Avantiplus. This Agreement applies to each and every occasion on which I participate in the Activity, unless Avantiplus and I reach another agreement which is recorded in writing and signed by both parties. The Activity is a dangerous recreational activity which involves significant risks of injury and damage, including the potential for permanent paralysis and/or death. The risks of the Activity are set out on page 1 of this agreement (under the heading Risks of the Activity ) and may also include other risks which are not set out in this Agreement. The natural conditions in which the Activity is performed may vary without warning. Avantiplus relies on the information provided by me in this document and I hereby state that all such information is accurate and complete. This document records the entire agreement between Avantiplus and me in relation to the Activity and my participation in it. If any term in this document is held to be void or unenforceable, it must be severed from the document and the terms that are not void or unenforceable will not be affected by the severance. RISK WARNING 2. I acknowledge that I have been warned of the Risks of the Activity. 3. I acknowledge that the Activity may involve risks which are not listed in the Risks of the Activity list on page 1. ASSUMPTION OF RISK 4. I knowingly, freely and voluntarily assume all of the Risks of the Activity, whether they are known or unknown to me at the time of signing this document. DRUGS AND/OR ALCOHOL 5. I am aware of the dangers associated with the consumption of alcohol, mind altering substance, drug or other substance which may impair my judgment or physical ability or capacity to safely participate in the Activity. 6. I warrant and certify that before and during the Activity, I will not consume any alcohol, mind altering substance, drug or other substance which may impair my judgement, physical ability or capacity to safely participate in the Activity. 7. I accept full responsibility for any injury, loss or damage associated with my consumption of alcohol, mind altering substance, drug or other substance which impairs my judgement, physical ability or capacity to safely participate in the Activity. 2

7 SAFETY 8. I agree that I am solely responsible for my own safety while I am participating in the Activity. 9. I agree that I will take all reasonable steps to ensure my own safety, including by wearing appropriate safety gear such as a helmet, and by keeping myself appropriately hydrated. MEDICAL CONDITION 10. I certify that I am physically fit and able to participate in the Activity and I have not been advised to not participate in the Activity by a qualified medical professional. 11. I warrant and certify that in this document I have disclosed any pre-existing medical or other conditions that may affect my ability or the ability of any other person to participate in the Activity. Apart from the conditions which I have disclosed in this document, there are no health related reasons or other problems which preclude my participation in the Activity. WAIVER, RELEASE AND INDEMNITY 12. To the extent permissible by law, I agree that the provisions of Schedule 2 The Australian Consumer Law of the Competition and Consumer Act 2010 (Cth) and any similar state legislative provisions (which provide for an implied warranty that services be rendered with due care and skill and that any material supplied in connection with those services will be reasonably fit for purpose) are expressly excluded and do not apply to this agreement. 13. I agree to release and hold harmless Avantiplus, its directors, officers, servants, employees, volunteers and agents from and against any liability arising out of any injury, loss, damage or death caused to me or my property or any other person arising from or in connection with my participation in the Activity, whether such injury, loss, damage or death was caused directly or indirectly by negligence, breach of contract or any way whatsoever other than where the injury, loss, damage or death was caused solely by the negligence of Avantiplus, its directors, officers, servants, employees, volunteers and agents. 14. I agree to indemnify and hold harmless Avantiplus, its directors, officers, servants, employees, volunteers and agents from all claims, damages, losses, injuries and expenses arising out of or resulting from my participation in the Activity. This indemnity extends to all claims made by any other person against Avantiplus, its directors, officers, servants, employees, volunteers and agents in respect of any injury, loss or damage arising out of or in connection with my participation in the Activity, other than where the injury, loss, damage or death was caused solely by the negligence of Avantiplus, its directors, officers, servants, employees, volunteers and agents. MISCELLANEOUS 15. I agree to comply with all rules and directions made or given by Avantiplus in connection with the Activity. I understand that if I fail to comply with any rules and/or directions of Avantiplus: (a) I may be injured or may injure someone else; and (b) I will not be permitted to continue the Activity and no refund will be given to me. 16. I agree to report all hazards, accidents, injuries, loss or damage sustained by me or any other person to Avantiplus immediately after I become aware of such hazards, accidents, injuries, loss or damage. 17. I agree that if I suffer any injury or illness while performing the Activity, Avantiplus may provide or arrange evacuation, first aid and medical treatment at my expense. I consent to receiving medical treatment in the event that I suffer any injury or illness while performing the Activity. 18. I understand that I may be photographed or videoed while participating in the Activity. I agree to allow any such photos or videos to be used for any purpose to be determined by Avantiplus in Avantiplus absolute discretion. 3

8 BY SIGNING THIS DOCUMENT, I EXPRESSLY ACKNOWLEDGE AND AGREE THAT: - I am over the age of 18 years old and I have mental capacity to sign this document - I have read this document and confirm that if I have been unsure about the term/s contained in it, I have advised an Avantiplus representative and the Avantiplus representative has explained the term/s to me - I fully understand the terms of this document - This document contains a release of liability and I have given up substantial legal rights by agreeing to the release of liability - I am participating in the Activity voluntarily, of my own free will and without any inducement, advice or representation being made to me by any person. - I have signed this document voluntarily, of my own free will and without any inducement, advice or representation being made to me by any person. Signature of participant Witness name Witness address Date Witness signature Date 4