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ZIPTREK ECOTOURS - PARTICIPANT CONSENT FORM

I have read and agree to be bound by the following conditions of participation in ZJV (NZ) Limited ("Ziptrek") 

adventure activities:

Disclosure of risk

I am aware that although Ziptrek will take all reasonable and practicable steps to minimise the hazards and risks involved in the adventure activity, there will still be an element of risk involved because of the nature of the activity. The primary risks being (but not limited to) those associated with taking part in an activity at height within a forest environment including fall from height, collision with object, equipment failure, changing weather conditions, natural hazards (such as fire, and earthquake), slips/trips and falls. 

Instructions & Equipment

I agree to comply at all times with all instructions given to me by any employees or agents of Ziptrek while undertaking a Ziptrek adventure activity to minimise the risk of harm to myself and others.

I acknowledge my duties under the Health and Safety at Work Act 2015 and agree to comply with Ziptrek's health and safety policies and procedures. I understand that Ziptrek reserves the right to end my trip at any time for health and safety reasons, and in such circumstances I will not be entitled to a refund of the purchase price for the activity. 

I understand I will be required to wear safety equipment as directed and agree to at all times wear the safety equipment throughout the adventure activities as directed.

I understand that if I have any safety concerns I should address them with the guides during the tour or post tour contact Ziptrek Ecotours via e-mail, phone or in person

Health & Injury

I am aware that the physical exertion required and the force exerted on the body during the adventure activities can activate or aggravate pre-existing physical injuries, conditions, or congenital defects. I understand that I should seek medical advice if I know or suspect that my physical condition may be incompatible with adventure activities, before undertaking the activities.  

I certify that I am physically fit and able to participate in Ziptrek adventure activities. Prior to signing this form, or prior to undertaking the Ziptrek adventure activity I have/will advise the activity operator of any pre-existing or existing medical conditions or recent injuries, but have made my own decision to participate in the adventure activity notwithstanding any potential risk to me because of my pre-existing/existing medical condition(s) or recent injuries.

Release of Liability

In consideration of Ziptrek allowing me to participate in its adventure activities, to the extent permitted by law, I release, waive, discharge and I fully indemnify Ziptrek, Ziptrek guides, and all persons and entities connected to Ziptrek from any loss or liability it may have in respect of any claim (other than a claim under the Consumer Guarantees Act 1993), however caused or arising, directly or indirectly, which relates to:

▪ any injury suffered by me, including any personal or mental injury I may suffer which is not 

covered by the provisions of the Accident Compensation Act 2001; and/or

▪ any damage or loss of my personal property; and/or

any other injury, loss, or expense suffered by me as a result of my participation in the adventure activities run by Ziptrek.

Photographs and Images

I consent to having photographs and/or videos of me taken while participating in the adventure activities and for these images to be published or otherwise used by Ziptrek for promotional, advertising, or marketing purposes.

Governing Laws

I agree that only the Law of New Zealand will apply to any dispute or claim arising out of my participation in a Ziptrek adventure activity.

By signing this form I understand and agree to the above terms and conditions of participation.

* This form must be signed by a guardian/parent if the participant is under the age of 18 years. By signing the

form the guardian/parent confirms that he/she has fully explained to the participant that they must at all times

comply with all instructions given by Ziptrek.

First Participant's Name

First Name*

Last Name*
First Participant's Date of Birth*
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*
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 be the first to know about Ziptrek Ecotours' latest news, events and special offers via email.
Your signed waiver will be sent to the email address provided here and is available for download for three days via URL attachment.
Phone Number

Phone Number: *
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
Booking Reference

Booking Reference Number: *

Your 4 or 5 digit booking reference number can be found in the top right corner of your email confirmation.


Parent(s) or 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 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*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
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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