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This waiver must be completed by all participants prior to riding with us at Empire Ride & Equip:

 

PARTICIPANT WAIVER

The following must be completed by all participants prior to riding at Empire Ride & Equip.  Where a participant is less than 18 years of age (a minor) a parent or guardian must complete and sign the document on their behalf. 

By signing this document on behalf of a minor(s) you hereby covenant and warrant that your answers provided are true and correct, that you are authorised to allow this minor(s) to participate, an hereby agree that you shall both/all be bound by this document and its conditions.

TO: Gonesky Pty Ltd trading as Empire Ride & Equip of 15 Century Drive Braeside, Victoria (including its directors, employees, agents and all other persons or entities in any capacity acting on its behalf (collectively and severally referred to as ‘Empire Ride & Equip’).

In consideration for, and as a condition of my entry to Empire Ride & Equip, I the participant agree as follows:

I acknowledge that the activities including but not limited to skateboarding, inline skating, scooter riding, BMX riding as well as the use of ramps, resi ramps and foam pits undertaken at Empire Ride & Equip (the ‘activities’) are dangerous recreational activities and there are inherent risks associated with these activities that could result in serious injury or death, or damage to property or to third parties.

I agree that this waiver applies to all lessons and coaching sessions and any other events administered by Empire Ride & Equip.

I acknowledge that the activities could result in serious injury or death, or damage to property due to the actions, omissions or negligence of others.

I acknowledge that the inherent risks include, but are not limited to:

  • the potential for collision between multiple participants or participants and course obstacles, spectators and Empire Ride & Equip employees;
  • the potential for participants to be struck by equipment being used by other participants;
  • the failure of participant or Empire Ride & Equip equipment, including equipment loaned and/or hired to the participants by Empire Ride & Equip;
  • the potential for participants to attempt manoeuvres or tricks, resulting in incorrect landing or falling;
  • the potential for participants to fall off ramps and equipment or other obstacles; and
  • the potential of another participant or other persons to act in a negligent manner that may contribute to injury to another, or others, such as not acting within his or her ability. 

I acknowledge that whilst Empire Ride & Equip takes reasonable steps to ensure the safety of all participants (such as mandatory helmet policy and providing supervision) it cannot ensure the safety of participants due to the danger and risks associated with the activities.

I agree to comply with the park rules and warnings as displayed throughout Empire Ride & Equip or as otherwise notified to me.

I certify that I am in good health, that I have no medical or physical conditions which could interfere with my safety in the activities, or else I willingly assume, and bear the costs of all risks, known or unanticipated, that may be created, directly or indirectly by any such condition.  Where there is any doubt as to my physical condition, I understand that I should seek medical advice prior to participating in the activities.

I consent to receiving any medical first aid treatment that Empire Ride & Equip consider necessary during or after the activities.

I agree that before participating in activities at Empire Ride & Equip, I will independently inspect the facilities and equipment.  I will immediately advise Empire Ride & Equip employees of any unsafe condition that I observe.  I will not participate in any activities until all unsafe conditions observed by me are remedied.

I expressly and voluntarily agree and promise to accept and assume all of the risks existing in the activities.

I hereby agree to release, discharge, defend, compensate, make good and indemnify Empire Ride & Equip from any and all claims, complaints, demands, or causes of action, for any personal injury or death for failing to comply with a statutory guarantee which are in any way connected with my participation in the activities or my use of Empire Ride & Equip’s equipment, land, or facilities, including any such claims, complaints, demands or causes of action which alleged neglect act or omissions of Empire Ride & Equip.

Further, I hereby release Empire Ride & Equip from other liability including, without limitation for loss or damage to personal property and indirect or consequential losses, where it has failed to comply with the statutory guarantees except to the extent of any liability imposed on Empire Ride & Equip under the Australian Consumer Law.

I agree I am responsible for using the facilities appropriately, participating at a suitable level and in a safe manner

I hereby grant permission to Empire Ride & Equip operators and owners, their successors and sponsors to use my name, image and likeness in direct connection with the activities for promotional broadcasting or reporting purposes in any and all manner and media, unless restricted by Privacy Legislation.

I acknowledge my registration is not transferable to any other person.

STATEMENT OF UNDERSTANDING

I acknowledge that I have read and understood the matters set out in this document and that either:

I am of lawful age and legally competent to give this acknowledgement and release for myself; or
I am of lawful age, I am the participant’s parent or guardian and I am legally competent to give this release on their behalf.

I acknowledge that the conditions set out in this Participant Form are contractual in nature, are intended to have legal effect and are not merely a warning or recital.  I have been advised to seek legal advice for any terms I don’t understand.  I have signed the document of my own free will without any representation or inducement by Empire Ride & Equip.

I Agree

 

First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information
My current skill level is: *
Beginner
Intermediate
Advanced
I mostly ride: *
Scooter
BMX
Skateboard
Inline
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

Last Name*
Second Participant's Date of Birth*
Second Participant's Information
My current skill level is: *
Beginner
Intermediate
Advanced
I mostly ride: *
Scooter
BMX
Skateboard
Inline
Third Participant's Name

First Name*

Middle Name

Last Name*
Third Participant's Date of Birth*
Third Participant's Information
My current skill level is: *
Beginner
Intermediate
Advanced
I mostly ride: *
Scooter
BMX
Skateboard
Inline
Fourth Participant's Name

First Name*

Middle Name

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information
My current skill level is: *
Beginner
Intermediate
Advanced
I mostly ride: *
Scooter
BMX
Skateboard
Inline
Fifth Participant's Name

First Name*

Middle Name

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information
My current skill level is: *
Beginner
Intermediate
Advanced
I mostly ride: *
Scooter
BMX
Skateboard
Inline
Sixth Participant's Name

First Name*

Middle Name

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information
My current skill level is: *
Beginner
Intermediate
Advanced
I mostly ride: *
Scooter
BMX
Skateboard
Inline
Seventh Participant's Name

First Name*

Middle Name

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information
My current skill level is: *
Beginner
Intermediate
Advanced
I mostly ride: *
Scooter
BMX
Skateboard
Inline
Eighth Participant's Name

First Name*

Middle Name

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information
My current skill level is: *
Beginner
Intermediate
Advanced
I mostly ride: *
Scooter
BMX
Skateboard
Inline
Ninth Participant's Name

First Name*

Middle Name

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information
My current skill level is: *
Beginner
Intermediate
Advanced
I mostly ride: *
Scooter
BMX
Skateboard
Inline
Tenth Participant's Name

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information
My current skill level is: *
Beginner
Intermediate
Advanced
I mostly ride: *
Scooter
BMX
Skateboard
Inline
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*
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

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*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information
My current skill level is: *
Beginner
Intermediate
Advanced
I mostly ride: *
Scooter
BMX
Skateboard
Inline
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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