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BAYSIDE ROCK CLIMBING – ("Bayside Rock")
A.C.N. 168 071 458
9 Network Drive, Carrum Downs, VIC, Australia 3201 – Tel: 03 9775 1557
WAIVER OF LIABILITY (Acknowledgement of Risk Agreement) 

PERSONAL RESPONSIBILITY: Participants are informed that climbing and other related activities involve risk and that all climbers and belayers must be willing to take personal responsibility for their own safety & actions and acknowledge the inherent risks involved in participating in the activities provided at Bayside Rock Climbing (Bayside Rock).

As acknowledgement of my understanding I agree to Initial each statement, sign below & declare all information as true & correct. I will NOT participate if I do not agree with any of the below statements or Bayside Rock Rules.

To minimise any such risk, I agree to comply with all Verbal Directions given by management and/or staff and further agree that I have read, understand & agree to comply with all Rules & Safety Instructions which may be printed on signs throughout this facility or displayed on the website www.baysiderock.com.au & will ask for an explanation to my satisfaction should I not fully understand, prior to commencing activities. Click Here to Initial > (Parent/Guardian if under 18)

I understand that these activities are physically demanding (increasing heart rate) & may cause panic, hyperventilation or even heart attack and I believe that I am fully capable and fit to participate in said activities and do so at my own risk. Click Here to Initial > (Parent/Guardian if under 18)

I accept full liability for my actions and the actions of any person in my care, whilst utilising the facilities of Bayside Rock & I understand this Waiver is ongoing & will apply to all future occasions in which I participate in the activities provided at Bayside Rock. I further understand this document is contractual and may be relied upon in any proceedings by myself, my heirs, executors or assigns. Click Here to Initial > (Parent/Guardian if under 18)

By signing this document I hereby release Bayside Rock, the owner of the premises and all employees, staff and assistants of Bayside Rock or any other persons involved in my participation of activities at Bayside Rock from any suit, demand, action or claim for compensation whether for personal injury or damage to property arising from my participation.

I HAVE HAD SUFFICIENT OPPORTUNITY TO READ THIS ENTIRE DOCUMENT. I HAVE READ AND UNDERSTOOD IT, AND I AGREE TO BE BOUND BY ALL OF IT'S TERMS.

Date: November 17, 2018

First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information

Medical Conditions
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

Last Name*
Second Participant's Date of Birth*
Second Participant's Information

Medical Conditions
Third Participant's Name

First Name*

Middle Name

Last Name*
Third Participant's Date of Birth*
Third Participant's Information

Medical Conditions
Fourth Participant's Name

First Name*

Middle Name

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information

Medical Conditions
Fifth Participant's Name

First Name*

Middle Name

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information

Medical Conditions
Sixth Participant's Name

First Name*

Middle Name

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information

Medical Conditions
Seventh Participant's Name

First Name*

Middle Name

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information

Medical Conditions
Eighth Participant's Name

First Name*

Middle Name

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information

Medical Conditions
Ninth Participant's Name

First Name*

Middle Name

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information

Medical Conditions
Tenth Participant's Name

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information

Medical Conditions
Participant's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

Medical Conditions
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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