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Earth Adventure General Disclaimer

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
First Participant's Signature*
Second Participant's Name

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

Last Name*
Tenth Participant's Date of Birth*
Parent or Guardian's Email Address

Email*

Confirm Email*
Acknowledgement of Risk

I acknowledge that Earth Adventure (Aust) Pty Ltd will provide myself/ my child with access to a variety of activities which will be supervised by employees of Earth Adventure (Aust) Pty Ltd ("the activities").

I acknowledge that these activities may have inherent risk involved and I acknowledge responsibility for myself/ my child participating in these activities.

I acknowledge that during all such times whilst myself / my child is participating in the activities I will not hold Earth Adventure (Aust) Pty Ltd liable for any personal injury or loss of property whatsoever and I agree to indemnify and keep indemnified Earth Adventure (Aust) Pty Ltd against all such injury or loss except to the extent that such personal injury or loss of property is occasioned by neglect, default or omission by Earth Adventure (Aust) Pty Ltd or their consultants, employees, contractors or agents (as the case maybe).

I agree that I will pay any reasonable cost of repair or replacement to equipment or facilities that may be damaged by actions of myself/ my child beyond that of normal wear and tear.

(If minor) I agree to instruct my son / daughter to follow the rules of activity participation and to follow instructions given for Earth Adventure (Aust) Pty Ltd and contractors facilities. I also agree to provide necessary warning information if my son/daughter has demonstrated signs of mental health conditions that will cause harm to property themselves or others.

I declare that the information which I have provided on this form is complete and correct and I will notify Earth Adventure (Aust) Pty Ltd any changes occur prior to the program commencing. Earth Adventure (Aust) Pty Ltd will not be held responsible for information that is incorrect or not provided as requested.

Medical
Do you have or your dependent have any conditions requiring medication, if yes please specify*
No
Yes

If yes, please provide further details
Do you or your dependent have any physical limitations that may prevent you from participating in this activity*
No
Yes

If yes, please provide further details
Photo Consent
I give permission for me or my child to be a part of group photos or video footage taken during participation within the activities by Earth Adventure (Aust) Pty Ltd for use in brochures, school newsletters, or other promotional material.*
No
Yes
COVID-19 Screening
Do you have any of the following symptoms? *
New or persistent cough
Shortness of breath or any difficulty breathing
Fever
Nil
Have you been in contact with anyone in the last 14 days who is experiencing symptoms?*
No
Yes
Have you been in contact with anyone who has since tested positive for Covid-19 or is currently in isolation awaiting results?*
No
Yes
Have you travelled interstate in the last month*
No
Yes

If yes, where have you travelled?
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*
I certify that I am 18 years of age or older
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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