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Thanks for booking in to ride at Middle Hill MTB! We look forward to seeing you here. Please complete this waiver before arrival. Thanks!

As you are probably aware, mountain biking is a dangerous sport. While riding at Middle Hill MTB you will encounter steep slopes and obstacles possibly on a narrow track and surfaces that may provide poor traction. There may be exposure to the tracks outside edge and steep drop offs. There is a possibility of injury or death when participating in this activity. You need to ride within your limits, respect the trails and other riders and always remember that you are in a remote area with limited access to emergency services. 

I understand that there are risks involved in the activities I will be undertaking. I also understand that an unpredictable or uncontrollable event may occur that could possibly cause me serious harm or death. I am aware of the implications of my voluntary participation and the consequences should I ignore the organisations safety management procedures and directions. I also am aware I have the right to refuse to undertake certain tasks or ride certain trails if I believe I cannot safely complete them.

I acknowledge that Middle Hill MTB will take all reasonable and practical steps to keep me safe while I am involved in these activities. However, I accept full responsibility for my own actions or inactions.

1. I am aware that the activity involves some physical exertion and the inherent dangers and risk including changeable weather conditions. 

2. I declare and confirm that I am physically fit and healthy, and that it is my responsibility to notify staff of any medical conditions and/or medications that I may require.

3. I will comply with all instructions of Middle Hill MTB and the volunteers and contractors working there.

4. I am aware that if I am or if I appear to be under the influence of alcohol or drugs I will not be permitted to participate in the activity, and I will not be entitled to a refund. 

5. I understand that it may be necessary for Middle Hill MTB to cancel the activity at short notice. Middle Hill MTB will not be responsible (to the extent permitted by law) for any loss arising from such a cancellation. 

6. I accept that Middle Hill MTB will not be responsible for, and I release, waive and hold harmless its officers, members, volunteers and contractors from all claims I may have in respect of any losses, damages, expenses or injury arising during or in conjunction with my participation in this activity, including any claims for damages caused by negligence of Middle Hill MTB its officers, members, volunteers and contractors together with any costs including legal fees that may be incurred as a result of any such claims, losses, damages or expenses, whether valid or not, (to the extent permitted by law), regardless of how that loss, damage, expense or injury is caused. 

7. I also indemnify Middle Hill MTB, its officers, members, volunteers and contractors against all claims, losses, damage, or expenses or claim that any of my guests or any one or more of my or their executors, administrators, heirs, next of kin, successors or assignees may have or assert and against any costs including legal fees that may be incurred as a result of any such claims, losses, damages or expenses, whether valid or not. 

8. If I am not a resident of New Zealand I declare that I will not endeavour to avoid conditions 6 and 7 by commencing legal action in another country. 

9. I consent to receive medical treatment which may be deemed to be necessary by Middle Hill MTB or it’s contractors in the case of injury, accident or illness during the course of undertaking this activity and also agree to indemnify Middle Hill MTB and its contractors in respect of such medical treatment. 

10. I give permission for any photos and film taken including me or my group to be used in future marketing and promotional material, unless I specifically ask the staff member not to use media including me or my group.

11. I understand that my personal information must be held with the company due to Covid-19 contact tracing requirements, and that Middle Hill MTB is required by law to check that I have a valid vaccine pass.

12. I have read, understood and accepted the terms and conditions and understand that Middle Hill MTB will rely on this declaration and on the information I have provided. 

First Participants Name

First Name*

Last Name*

Phone*
First Participants Age Acknowledgment*
First Participants Date of Birth*
I certify that I am 16 years of age or older
First Participants Medical Information
Please advise if the participant has any of the following medical conditions:
Serious allergies
Asthma or other respiratory problems
Type 1 Diabetes or other blood-related condition
Is or may be pregnant
Any other significant pre-existing medical conditions

If any of the above are selected, the participant should carry any essential medication (eg asthma inhaler, adrenalin etc) with them at all times. Please advise staff on the day if there is any significant medical information we should know about.

First Participants Signature*
Second Participants Name

First Name*

Last Name*

Phone*
Second Participants Date of Birth*
Second Participants Medical Information
Please advise if the participant has any of the following medical conditions:
Serious allergies
Asthma or other respiratory problems
Type 1 Diabetes or other blood-related condition
Is or may be pregnant
Any other significant pre-existing medical conditions

If any of the above are selected, the participant should carry any essential medication (eg asthma inhaler, adrenalin etc) with them at all times. Please advise staff on the day if there is any significant medical information we should know about.

Third Participants Name

First Name*

Last Name*

Phone*
Third Participants Date of Birth*
Third Participants Medical Information
Please advise if the participant has any of the following medical conditions:
Serious allergies
Asthma or other respiratory problems
Type 1 Diabetes or other blood-related condition
Is or may be pregnant
Any other significant pre-existing medical conditions

If any of the above are selected, the participant should carry any essential medication (eg asthma inhaler, adrenalin etc) with them at all times. Please advise staff on the day if there is any significant medical information we should know about.

Fourth Participants Name

First Name*

Last Name*

Phone*
Fourth Participants Date of Birth*
Fourth Participants Medical Information
Please advise if the participant has any of the following medical conditions:
Serious allergies
Asthma or other respiratory problems
Type 1 Diabetes or other blood-related condition
Is or may be pregnant
Any other significant pre-existing medical conditions

If any of the above are selected, the participant should carry any essential medication (eg asthma inhaler, adrenalin etc) with them at all times. Please advise staff on the day if there is any significant medical information we should know about.

Fifth Participants Name

First Name*

Last Name*

Phone*
Fifth Participants Date of Birth*
Fifth Participants Medical Information
Please advise if the participant has any of the following medical conditions:
Serious allergies
Asthma or other respiratory problems
Type 1 Diabetes or other blood-related condition
Is or may be pregnant
Any other significant pre-existing medical conditions

If any of the above are selected, the participant should carry any essential medication (eg asthma inhaler, adrenalin etc) with them at all times. Please advise staff on the day if there is any significant medical information we should know about.

Sixth Participants Name

First Name*

Last Name*

Phone*
Sixth Participants Date of Birth*
Sixth Participants Medical Information
Please advise if the participant has any of the following medical conditions:
Serious allergies
Asthma or other respiratory problems
Type 1 Diabetes or other blood-related condition
Is or may be pregnant
Any other significant pre-existing medical conditions

If any of the above are selected, the participant should carry any essential medication (eg asthma inhaler, adrenalin etc) with them at all times. Please advise staff on the day if there is any significant medical information we should know about.

Seventh Participants Name

First Name*

Last Name*

Phone*
Seventh Participants Date of Birth*
Seventh Participants Medical Information
Please advise if the participant has any of the following medical conditions:
Serious allergies
Asthma or other respiratory problems
Type 1 Diabetes or other blood-related condition
Is or may be pregnant
Any other significant pre-existing medical conditions

If any of the above are selected, the participant should carry any essential medication (eg asthma inhaler, adrenalin etc) with them at all times. Please advise staff on the day if there is any significant medical information we should know about.

Eighth Participants Name

First Name*

Last Name*

Phone*
Eighth Participants Date of Birth*
Eighth Participants Medical Information
Please advise if the participant has any of the following medical conditions:
Serious allergies
Asthma or other respiratory problems
Type 1 Diabetes or other blood-related condition
Is or may be pregnant
Any other significant pre-existing medical conditions

If any of the above are selected, the participant should carry any essential medication (eg asthma inhaler, adrenalin etc) with them at all times. Please advise staff on the day if there is any significant medical information we should know about.

Ninth Participants Name

First Name*

Last Name*

Phone*
Ninth Participants Date of Birth*
Ninth Participants Medical Information
Please advise if the participant has any of the following medical conditions:
Serious allergies
Asthma or other respiratory problems
Type 1 Diabetes or other blood-related condition
Is or may be pregnant
Any other significant pre-existing medical conditions

If any of the above are selected, the participant should carry any essential medication (eg asthma inhaler, adrenalin etc) with them at all times. Please advise staff on the day if there is any significant medical information we should know about.

Tenth Participants Name

First Name*

Last Name*

Phone*
Tenth Participants Date of Birth*
Tenth Participants Medical Information
Please advise if the participant has any of the following medical conditions:
Serious allergies
Asthma or other respiratory problems
Type 1 Diabetes or other blood-related condition
Is or may be pregnant
Any other significant pre-existing medical conditions

If any of the above are selected, the participant should carry any essential medication (eg asthma inhaler, adrenalin etc) with them at all times. Please advise staff on the day if there is any significant medical information we should know about.

Parent or Guardian's Email Address

Email
Your signed waiver will be sent to the email address provided here and is available for download for three days via URL attachment.
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 16 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


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*

Last Name*

Phone*
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
I certify that I am 16 years of age or older
Parent or Guardian's Medical Information
Please advise if the participant has any of the following medical conditions:
Serious allergies
Asthma or other respiratory problems
Type 1 Diabetes or other blood-related condition
Is or may be pregnant
Any other significant pre-existing medical conditions

If any of the above are selected, the participant should carry any essential medication (eg asthma inhaler, adrenalin etc) with them at all times. Please advise staff on the day if there is any significant medical information we should know about.

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


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