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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 falling from height, collisions with objects, equipment malfunction or failure, changing weather conditions, natural hazards (such as falling objects, fire, earthquake or terrain instability), slips/trips and falls. I acknowledge that these risks cannot be completely eliminated, even with proper supervison and safety systems.

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 may 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 via email, 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.  

To the best of my knowledge, I confirm that I am fit to participate in the adventure activity. I confirm that I have disclosed below, any relevant medical conditions, injuries, or limitations which might affect my safe participation in the adventure activity.

I acknowledge and agree that Ziptrek may exclude me from participating in the adventure activity if at any time (whether prior to, or during the activity) it considers that my participation in the adventure activity is unsafe.

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 which cannot be excluded at law, inlcuding 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 acknowledge that Ziptrek staff may take photographs and videos of me while I am participating in the adventure activities. I understand that Ziptrek may use those photographs and videos for promotional and marketing purposes, as described in the Ziptrek Privacy Policy (a copy of which is available on request). If I do not want photographs or videos of me to be taken, I will inform Ziptrek staff on arrival.

Governing Laws

I agree that any dispute or claim arising in connection with my participation in a Ziptrek adventure activity shall be governed by New Zealand law.

Privacy

All personal information that you provide to Ziptrek via this form or otherwise in connection with your participation in Ziptrek's adventure activities is collected and managed in accordance with the Ziptrek Privacy Policy (a copy of which can be made available to you on request).

First Participant's Name
First Name*
Last Name*
First Participant's Date of Birth*
Date of Birth
Participant's Disclosure
Do you have, or have you recently experienced, any condition or injury that may reasonably be affected or aggravated by physical exertion, or force being exerted on the body, including but not limited to, pregnancy, a back injury, or other medical condition?*
No
Yes

If yes, please provide further details below:
First Participant's Signature*
Second Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Participant's Disclosure
Do you have, or have you recently experienced, any condition or injury that may reasonably be affected or aggravated by physical exertion, or force being exerted on the body, including but not limited to, pregnancy, a back injury, or other medical condition?*
No
Yes

If yes, please provide further details below:
Third Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Participant's Disclosure
Do you have, or have you recently experienced, any condition or injury that may reasonably be affected or aggravated by physical exertion, or force being exerted on the body, including but not limited to, pregnancy, a back injury, or other medical condition?*
No
Yes

If yes, please provide further details below:
Fourth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Participant's Disclosure
Do you have, or have you recently experienced, any condition or injury that may reasonably be affected or aggravated by physical exertion, or force being exerted on the body, including but not limited to, pregnancy, a back injury, or other medical condition?*
No
Yes

If yes, please provide further details below:
Fifth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Participant's Disclosure
Do you have, or have you recently experienced, any condition or injury that may reasonably be affected or aggravated by physical exertion, or force being exerted on the body, including but not limited to, pregnancy, a back injury, or other medical condition?*
No
Yes

If yes, please provide further details below:
Sixth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Participant's Disclosure
Do you have, or have you recently experienced, any condition or injury that may reasonably be affected or aggravated by physical exertion, or force being exerted on the body, including but not limited to, pregnancy, a back injury, or other medical condition?*
No
Yes

If yes, please provide further details below:
Seventh Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Participant's Disclosure
Do you have, or have you recently experienced, any condition or injury that may reasonably be affected or aggravated by physical exertion, or force being exerted on the body, including but not limited to, pregnancy, a back injury, or other medical condition?*
No
Yes

If yes, please provide further details below:
Eighth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Participant's Disclosure
Do you have, or have you recently experienced, any condition or injury that may reasonably be affected or aggravated by physical exertion, or force being exerted on the body, including but not limited to, pregnancy, a back injury, or other medical condition?*
No
Yes

If yes, please provide further details below:
Ninth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Participant's Disclosure
Do you have, or have you recently experienced, any condition or injury that may reasonably be affected or aggravated by physical exertion, or force being exerted on the body, including but not limited to, pregnancy, a back injury, or other medical condition?*
No
Yes

If yes, please provide further details below:
Tenth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Participant's Disclosure
Do you have, or have you recently experienced, any condition or injury that may reasonably be affected or aggravated by physical exertion, or force being exerted on the body, including but not limited to, pregnancy, a back injury, or other medical condition?*
No
Yes

If yes, please provide further details below:
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
Please check this box if you would like to receive information about Ziptrek Ecotours' latest new, 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: Please include country code *
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.


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.



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*
Date of Birth
Participant's Disclosure
Do you have, or have you recently experienced, any condition or injury that may reasonably be affected or aggravated by physical exertion, or force being exerted on the body, including but not limited to, pregnancy, a back injury, or other medical condition?*
No
Yes

If yes, please provide further details below:
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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