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Archer Access Pty Ltd

21 DARCY LANE

WEST KALGOORLIE, WA, 6430

Archer Access Pty Ltd conducts minesite and emergency response training, rock climbing and bouldering activities (“Activities”). Participating in any Activities with Archer Access Pty Ltd is inherently dangerous and there is significant risk of injury, disability or death. If you do not wish to be exposed to such risks, then you should not participate in the Activities.

I acknowledge that the many inherent risks and hazards associated with participating in Activities at Archer Access Pty Ltd include but are not limited to:

  1. falling including falling from height and impacting against walls or other people or the ground;
  2. being crushed or burnt;
  3. over exertion or dehydration;
  4. dangerous, reckless or careless acts of other participants in Activities leading to accidents; and
  5. the failure or unsuitability of facilities to ensure my safety

and as a consequence, personal injury (including abrasions, wounds or cuts, broken bones, crushing injuries including organ damage, burns, paralysis and spinal injury) or even death can occur.  I voluntarily assume and accept all such risks and waive the right to bring any action, claim or demand for any personal injury or death in any way whatsoever caused by or arising from or in connection with my participation in Activities.

I acknowledge and agree that:

  1. I am in good health and am physically fit and free from any medical conditions or pre-existing health issues or impairment that could increase the chance of an accident or that will be detrimental to my health if I do have an accident while participating in Activities.  I am not pregnant.
  2. I am not under the influence of alcohol or any drugs, whether illicit or prescription, which might affect my perception, strength or coordination or my ability generally to participate safely in Activities.  I understand I will be required to leave and not return for a minimum of 24 hours if Archer Access Pty Ltd personnel suspect I am under the influence of alcohol or drugs, and they do not have to test me for this.

I consent to receive emergency medical treatment in the event of illness or injury and authorise Archer Access Pty Ltd and its personnel to take all steps considered by them to be reasonably necessary to protect my welfare in this event, including arranging ambulance transportation, and agree to pay the cost of such treatment and other steps taken.

I agree to comply with all policies, signs, rules, regulations and verbal directions of Archer Access Pty Ltd or its personnel and I acknowledge that Archer Access Pty Ltd may suspend or cancel my access to Activities with no notice in its absolute discretion for non-compliance with any signs, rules or directions or for reckless or careless conduct.  At all times while participating in Activities I will act with due care for my own safety and the safety of others.

I acknowledge I have been provided with a copy of the current rules for participating in Activities and I have had the opportunity to read these carefully and have read them carefully and have queried anything I don’t understand.

In exchange for being able to participate in Activities, I agree:

  1. To release Archer Access Pty Ltd and its officers and personnel from all liability for:
  • my death;
  • any physical or mental injury, disease, condition or state of affairs (including the aggravation, acceleration or recurrence of such an injury, disease, condition or state of affairs) that is or may be harmful or disadvantageous to me; or
  • any loss of, theft of or damage to my personal property,

howsoever arising from or in connection with my participation in Activities;

  1. to indemnify and hold harmless and keep indemnified Archer Access Pty Ltd and its officers and personnel to the maximum extent permitted by law in respect of any claim by any person arising out of or in connection with Activities; and
  2. to attend or participate in Activities at my own risk.

This release and indemnity continues perpetually and binds my heirs, successors, executors, personal representatives and assigns.

I acknowledge and agree that:

  1. nothing in this document prevents Archer Access Pty Ltd from relying on any laws that limit or preclude their liability; and
  2. nothing in this document excludes any term or guarantee which cannot be excluded at law. However, the liability of Archer Access Pty Ltd is limited to the minimum liability allowed at law.

I have read, understood, acknowledge, and agree to the above including the exclusion of statutory guarantees, warning, assumption of risk, release and indemnity and I agree to these freely without any inducement.

I understand this is a legal document and acknowledge I have been given the opportunity to seek legal advice before signing it.  I acknowledge and agree that this document is ongoing and all acknowledgements I make in this document will apply on each occasion I participate in Activities in the future as if I signed it again on that day.

First Participant's Name

First Name*

Middle Name

Last Name*

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

Company if applicable
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

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

Company if applicable
Third Participant's Name

First Name*

Middle Name

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

Company if applicable
Fourth Participant's Name

First Name*

Middle Name

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

Company if applicable
Fifth Participant's Name

First Name*

Middle Name

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

Company if applicable
Sixth Participant's Name

First Name*

Middle Name

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

Company if applicable
Seventh Participant's Name

First Name*

Middle Name

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

Company if applicable
Eighth Participant's Name

First Name*

Middle Name

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

Company if applicable
Ninth Participant's Name

First Name*

Middle Name

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

Company if applicable
Tenth Participant's Name

First Name*

Middle Name

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

Company if applicable
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

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 18 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*

Middle Name

Last Name*

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

Company if applicable
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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