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BIRTHDAY PARTY WAIVER

We are so excited to have you join us at Bungee Fitness in Tuggerah. Birthday parties are a lot of fun! 

Participants will have an opportunity to experience the aerial hammock, aerial silks, static trapeze, aerial hoop and the super fun bungee's. 

I Agree
I  acknowledge that participation in activity programs delivered by Bungee Fitness Australia involve certain risks. I accept that, despite precautions being taken by Bungee Fitness Australia staff, accidents and incidents causing physical injury may occur.

I Agree
I declare my child/ren physically and medically fit, free from impairment and able to reasonably participate in the chosen activities. All details relating to my child/ren’s medical, physical or management needs that are relevant to the care of my child/ren by Bungee Fitness Australia staff and/or that may affect my child/ren’s participation are provided.

I Agree
By signing this form, I, on behalf of my child/ren, agree to release, waive and discharge Bungee Fitness Australia and its employees/contractors from liability for any personal injury that they may experience, and/or property loss/damage, arising from participation in Bungee Fitness Australia birthday party activities.

I Agree
I understand that Bungee Fitness Australia may need to contact me in the event of an accident, injury or illness. I agree to collect or make arrangements for the collection of my child/ren if he/she becomes unwell during the birthday party.

First Participant's Name

First Name*

Last Name*
First Participant's Age Acknowledgment*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
First Participant's Information
Does the participant have any medical condition, injury, disability, allergies or other relevant issue Bungee Fitness staff should be aware of? *
No
Yes - please provide additional details below

Details of any medical condition, injury, disability, allergy or other issue.
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Information
Does the participant have any medical condition, injury, disability, allergies or other relevant issue Bungee Fitness staff should be aware of? *
No
Yes - please provide additional details below

Details of any medical condition, injury, disability, allergy or other issue.
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Information
Does the participant have any medical condition, injury, disability, allergies or other relevant issue Bungee Fitness staff should be aware of? *
No
Yes - please provide additional details below

Details of any medical condition, injury, disability, allergy or other issue.
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information
Does the participant have any medical condition, injury, disability, allergies or other relevant issue Bungee Fitness staff should be aware of? *
No
Yes - please provide additional details below

Details of any medical condition, injury, disability, allergy or other issue.
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information
Does the participant have any medical condition, injury, disability, allergies or other relevant issue Bungee Fitness staff should be aware of? *
No
Yes - please provide additional details below

Details of any medical condition, injury, disability, allergy or other issue.
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information
Does the participant have any medical condition, injury, disability, allergies or other relevant issue Bungee Fitness staff should be aware of? *
No
Yes - please provide additional details below

Details of any medical condition, injury, disability, allergy or other issue.
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information
Does the participant have any medical condition, injury, disability, allergies or other relevant issue Bungee Fitness staff should be aware of? *
No
Yes - please provide additional details below

Details of any medical condition, injury, disability, allergy or other issue.
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information
Does the participant have any medical condition, injury, disability, allergies or other relevant issue Bungee Fitness staff should be aware of? *
No
Yes - please provide additional details below

Details of any medical condition, injury, disability, allergy or other issue.
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information
Does the participant have any medical condition, injury, disability, allergies or other relevant issue Bungee Fitness staff should be aware of? *
No
Yes - please provide additional details below

Details of any medical condition, injury, disability, allergy or other issue.
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information
Does the participant have any medical condition, injury, disability, allergies or other relevant issue Bungee Fitness staff should be aware of? *
No
Yes - please provide additional details below

Details of any medical condition, injury, disability, allergy or other issue.
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
Photo Release
I give permission for my child/ren to be photographed/filmed during participation in activities at Bungee Fitness Australia. This material may be used at some stage for Bungee Fitness Australia promotional purposes. *
Yes
No
Who is having a party?

What is the name of the birthday boy/girl whose party you will be attending? *
Parent(s) or 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*

Last Name*

Phone*
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Information
Does the participant have any medical condition, injury, disability, allergies or other relevant issue Bungee Fitness staff should be aware of? *
No
Yes - please provide additional details below

Details of any medical condition, injury, disability, allergy or other issue.
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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