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PARTICIPANT AGREEMENT & ACKNOWLEDGEMENT OF RISK

  1. In this Participant Agreement: 
    a. The “activities” shall include rock climbing activities including indoor and outdoor top rope climbing, lead climbing, bouldering and abseiling.
    b. “TRAC’ shall mean Geelong RockClimbing PTY LTD T/A The Rock Adventure Centre, Rear 403 Pakington Street, Newtown 3220.
  2. I am aware that the activities are dangerous undertakings and in undertaking such activities I do so at my own risk.
  3. I agree that I will not participate in any of the activities before taking part in a training session conducted by an instructor of TRAC.
  4. I agree that I will not participate in any of the activities or training for those activities if I have consumed alcohol in the twelve hours preceding training or participation in the activities.
  5. I agree to obey at all times the rules of TRAC and all reasonable requests and directions of instructors of TRAC.
  6. I accept responsibility for my personal belongings whilst participating in the activities and TRAC is absolved by me from all liability howsoever arising from theft, loss or damage of my belongings whilst participating in the activities whether to not such theft, loss or damage is due to any negligent act, breach of duty, default and/or omission on the part of TRAC.
  7. I am also aware that it is a condition of participation in the activities that TRAC, its directors, instructors, servants or agents are absolved from all liability howsoever arising from injury or damage howsoever caused (whether fatal or otherwise) arising out of participating in the activities or in any way whatsoever due to any negligent act, breach of duty, default and/or omission on the part of TRAC, its directors, instructors, servants or agents.
  8. Without limiting paragraph 7 herein, I absolve TRAC, its directors, instructors, servants or agents from any loss, damage or injury caused directly or indirectly from a defect or defects in equipment (including but not limited to, ropes, harnesses and shoes) used by me whilst participating in any of the activities, regardless of whether that equipment is inspected by a director, instructor, servant or agent of TRAC prior to commencing any of the activities.
  9. I am also aware that any person taking part in the activities carried out by TRAC is only permitted to do so on the distinct understanding that they do so at their own risk.
  10. In the event that I am injured whilst participating in activities carried out by TRAC and require urgent medical attention, I authorise TRAC to make all arrangements TRAC in its sole discretion shall consider necessary to obtain medical treatment, including but not limited to the request for an ambulance, and I agree to indemnify TRAC for the cost of those necessary arrangements and I release TRAC from any claim if for any reason medical treatment is not obtained or is inadequate.

I DO HEREBY ACKNOWLEDGE that of my own free will and desire I have contracted with TRAC for instruction and training in the activities and that I have read and understood the warnings above. I am signing this form on behalf of myself &/or all participants listed above as their parent/legal guardian or the responsible adult with permission to sign on their behalf.

Dated: September 20, 2020 

First Participant's Name

First Name*

Last Name*

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

MEDICAL NOTES: Relevant existing medical conditions, allergies, etc
First Participant's Signature*
Second Participant's Name

First Name*

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

MEDICAL NOTES: Relevant existing medical conditions, allergies, etc
Third Participant's Name

First Name*

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

MEDICAL NOTES: Relevant existing medical conditions, allergies, etc
Fourth Participant's Name

First Name*

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

MEDICAL NOTES: Relevant existing medical conditions, allergies, etc
Fifth Participant's Name

First Name*

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

MEDICAL NOTES: Relevant existing medical conditions, allergies, etc
Sixth Participant's Name

First Name*

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

MEDICAL NOTES: Relevant existing medical conditions, allergies, etc
Seventh Participant's Name

First Name*

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

MEDICAL NOTES: Relevant existing medical conditions, allergies, etc
Eighth Participant's Name

First Name*

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

MEDICAL NOTES: Relevant existing medical conditions, allergies, etc
Ninth Participant's Name

First Name*

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

MEDICAL NOTES: Relevant existing medical conditions, allergies, etc
Tenth Participant's Name

First Name*

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

MEDICAL NOTES: Relevant existing medical conditions, allergies, etc
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*
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Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Contact Information

Home Phone
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*

Last Name*

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

MEDICAL NOTES: Relevant existing medical conditions, allergies, etc
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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