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158 Ferny Ave, Surfers Paradise QLD 4217

PO Box 876, Main Beach QLD 4217

0409 340 624

fliteboard.com/goldcoast

FLITESCHOOL OPERATIONS PTY LTD

ABN: 50 653 840 549


Assumption of Risk

Activities Waiver Form

 

I, 


Hereby covenant, acknowledge and agree that so far as permitted by the Trade Practices Act 1974 (Cth) and the Fair Trading Act 1989 (QLD):

 

Important Notice – You Must Read This Carefully Acknowledgement, Waiver and Indemnity (“Release”)


In consideration for and as a condition of participation in the activity provided at Fliteboard Gold Coast, including without limitation dock and waterfront access together with riding a Fliteboard (the “Activity”), I agree to assume all risks of participation in the Activity including, but not limited to, death, bodily injury, disability or psychological injury or damage including property damage on my own behalf and on behalf of my partner and our children, and on behalf of my and their heirs, executors and administrators. I further agree to release and forever discharge Fliteschool Operations Pty Ltd ABN (50 653 840 549) trading as Fliteboard Gold Coast, it’s shareholders, directors, employees, agents, representatives, successors and assigns (“Fliteboard Parties”) of and from all liabilities, claims, actions, damages, costs or expenses, of any nature arising out of or in any way connected with my/our participation in the Activity, and further agree to indemnify and hold each of the Fliteboard Parties harmless against any and all such liabilities, claims, actions, damages, costs or expenses (including legal fees).

I further understand that this Release includes any claims based on the negligence, action or inaction of any of the Fliteboard Parties and covers bodily injury (including death) and property damage, whether suffered by me or my family, before, during or after such participation. I further authorize medical treatment for myself or family member, at my cost if the need arises.

I am aware that the Activity has inherent risks, dangers and hazards associated, including but not limited to risks associated with equipment failure, immersion in or under water, slipping and falling, harm caused by marine creatures, acts of fellow participants or risk that may not be known or anticipated; and I specifically assume such

risks. I acknowledge that each of my family members is physically fit and I will not hold the Fliteboard Parties responsible if we are injured as a result of any medical problems or complications which occur whilst participating in the Activity.

I acknowledge and agree that in the event of any incident or accident I shall not make any press release, public statement or otherwise make public the events and circumstances of any such incident or accident.

I acknowledge and agree that a person shall not be permitted to participate in the Activity if they:

  • are unable to comprehend or disregards safety instructions.
  • are under the influence of drugs/alcohol or otherwise similarly impaired.
  • ·are under age requirements.
  • are unaccompanied and unable to participate alone due to physical or mental impairment

I Agree

April 18, 2024


Please select who will be participating...
AdultMinor
Continue
First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Medical Declaration Form (Confidential)

GENERAL INFORMATION


Age *

Nationality *
Can you Swim?*
Yes
No
If you can swim, please choose your ability.*
25m
50m
100m
1k+
Have you hydrofoiled before?*
Yes
No
Have you ingested alcohol within the last 8 hours?*
Yes
No
Have you used any recreational drugs within the last 8 hours?*
Yes
No

MEDICAL QUESTIONS

Are you pregnant?*
Yes
No
Do you have a pacemaker?*
Yes
No
Are you suffering from any medical condition/s that may be made worse by exertion? Examples include: heart conditions, asthma, some lung diseases, etc.*
Yes
No

If yes, please provide details:
Are you suffering from any condition that may affect your consciousness? Examples include: Epiliepsy, diabetes, etc.*
Yes
No

If yes, please provide details:
Are you taking any prescribed medication (other than oral contraceptives)?*
Yes
No

If yes, please list:
Are you suffering from asthma that can be brought on by cold water or salt water mist?*
Yes
No
Are you aware that concealment of any condition incompatible with safe swimming, snorkeling or other physical activities may put your health or life at risk?*
Yes

Disclaimer

The information I have provided about my medical history is accurate to the best of my knowledge. I agree to accept responsibility for omissions regarding my failure to disclose any existing or past health condition. I have been advised that if I have any concerns about my medical conditions, fitness level or swimming ability I should inform the Fliteboard Gold Coast staff members.


First Participant's Signature*
Parent or Guardian's Email Address

Email
Check to receive information, news, and discounts by e-mail.
A signed copy of this waiver will be sent to the email address you provide.
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*

I have been advised of the Activity and understand the information provided. I represent and warrant that I have authority to sign this Release on behalf of myself, partner and children who accompany me as listed below. I have read this Release, fully understand its terms, understand that I have given up substantial legal rights by signing it, and sign it freely and voluntarily and no inducement, statements or representations have been made with respect thereto.

Please Note Age Restrictions: A minimum of 12 years to hydrofoil. Minors up to and including 13 years of age must be accompanied by a participating adult.

FOR PARTICIPANTS OF MINORITY AGE (UNDER AGE 18 AT THE TIME OF SIGNING) This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her release as provided above of all the Fliteboard Parties, and for myself, my heirs, assigns and next of kin, I release and agree to indemnify and hold harmless the Fliteboard Parties from any and all liabilities arising from my minor child’s involvement or participation in the Activity as provided above, including negligence , to the fullest extent permitted by law.



By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Medical Declaration Form (Confidential)

GENERAL INFORMATION


Age *

Nationality *
Can you Swim?*
Yes
No
If you can swim, please choose your ability.*
25m
50m
100m
1k+
Have you hydrofoiled before?*
Yes
No
Have you ingested alcohol within the last 8 hours?*
Yes
No
Have you used any recreational drugs within the last 8 hours?*
Yes
No

MEDICAL QUESTIONS

Are you pregnant?*
Yes
No
Do you have a pacemaker?*
Yes
No
Are you suffering from any medical condition/s that may be made worse by exertion? Examples include: heart conditions, asthma, some lung diseases, etc.*
Yes
No

If yes, please provide details:
Are you suffering from any condition that may affect your consciousness? Examples include: Epiliepsy, diabetes, etc.*
Yes
No

If yes, please provide details:
Are you taking any prescribed medication (other than oral contraceptives)?*
Yes
No

If yes, please list:
Are you suffering from asthma that can be brought on by cold water or salt water mist?*
Yes
No
Are you aware that concealment of any condition incompatible with safe swimming, snorkeling or other physical activities may put your health or life at risk?*
Yes

Disclaimer

The information I have provided about my medical history is accurate to the best of my knowledge. I agree to accept responsibility for omissions regarding my failure to disclose any existing or past health condition. I have been advised that if I have any concerns about my medical conditions, fitness level or swimming ability I should inform the Fliteboard Gold Coast staff members.


Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of a signature on paper. You have the right to request that you sign a paper copy instead and may, on written request, obtain a paper copy of an electronic record from us. No fee will be charged and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents continues until you notify us in writing that you no longer wish to use an electronic signature. You should always make sure that we have a current email address to contact you regarding any changes


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