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Ten4 Bouldering

7-11a Anne St TAMWORTH NSW 2340

ABN 16167453152 Ph: (02) 67 655457

www.ten4bouldering.com

Risk Warning & Waiver

I, hereby agree to the following:

1. I recognize that the use of the TEN4 facilities and all related equipment and/or property (collectively, the “TEN4 Facility”) have known and unknown risks of injury, including but not limited to: physical or emotional injury, paralysis, death, or damage to myself, to property or to third parties.

2. That I am participating in the open sessions, classes, programs or workshops offered by TEN4 during which I will receive information and instruction about various physical fitness programs. I recognize that fitness programs require physical exertion that may be strenuous and may cause physical injury, and I am fully aware of the risks and hazards involved.

3. I understand that it is my responsibility to consult with a physician prior to and regarding my participation in the TEN4 classes, programs or workshops. I represent and warrant that I am physically fit and I have no medical condition that would prevent my full participation in the exercise classes, programs or workshops. I further represent and warrant that I will not be under the influence of any substance, which would impair my ability to undertake activities in the TEN4 Facility.

4. In consideration of being permitted to participate in open gym sessions, classes, programs or workshops, I agree to assume full responsibility for any risks, injuries or damages, known or unknown, which I might incur as a result of participating in the program.

5. In consideration of being permitted to participate in TEN4 open gym sessions, classes, programs or workshops, I knowingly, voluntarily and expressly waive any claim I may have against TEN4 for injury or damages that I may sustain as a result of participating in the program.

6. In consideration of TEN4 permitting to use the TEN4 Facility, I, my spouse, assignees, heirs, guardians, and legal representatives hereby expressly assume all risks in using the TEN4 Facility and voluntarily indemnify, release from liability, agree to defend and hold harmless TEN4 and its subsidiaries and affiliates and any of their officers, directors, employees, agents, insurance carriers and representatives for any accident, injury, illness, death, loss, theft, damage to person or property, or other consequences suffered by me or my child arising or resulting directly or indirectly from my or my child’s use of the TEN4 Facility, including but not limited to, claims arising from or related to TEN4 negligence and/or products liability, including strict products liability, except that which is the result of gross negligence and/or wanton misconduct.

7. In the event that my child or I are injured, I agree to assume financial obligation, either through my health insurance, or through some other means, for any medical costs that my child or I incurs. TEN4  assumes no responsibility for any medical expenses, injury or damage suffered by me or my child in connection with my or my child’s use of the TEN4 Facility.

8. I, my heirs and legal representative, on my own behalf and / or on behalf of my child, forever release waive, discharge and covenant not to sue the TEN4 , its directors, owners, shareholders, officers, parents, affiliates, subsidiaries, coaches, employees volunteers, sponsors, officials and / or agents (collectively, the “Releasees”) for any injury or death caused by their negligence or other acts while I or my child are on or about the TEN4 Facility or using equipment or participating in any program affiliated with the TEN4, including training exercises, gymnastics, personal training, open gym hours and activities, and open gym use.

9. I agree as an adult participant, or as the parent / legal guardian of a minor participant, in consideration for being permitted to use the TEN4 Facility, grant TEN4 and affiliated entities, officers, directors, partners, shareholders, employees, agents, successors and assigns, the irrevocable right and permission to photograph and / or record me or my child in connection with TEN4, and to use the photograph and/ or recording with or without name identification for all purposes, including advertising and promotional purposes, in any manner and in any and all media now or hereafter known, in perpetuity throughout the world, without restriction as to alteration. I waiver any right to inspect or approve the use of any photographs or recordings, and acknowledge and agree that the rights granted in this release are without compensation of any kind.

10. I promise to hold blameless TEN4 in the event that my child or I suffer bodily injury or harm, and 000 or any other law enforcement agency is summoned and provides aid to either my child or myself. I promise to waive to the greatest extent possible liability for emergency services provided to either my child or myself and for any resulting consequences while on the TEN4 Facility or subsequently thereafter.

11. I expressly agree that this release is intended to be as broad and inclusive as the State of NSW will allow and that if any portion is held invalid, I agree that the balance shall, not withstanding, continue in full legal force and effect.

12. I hereby acknowledge that the TEN4 has rules and policies in place regarding safety, use of the TEN4 Facility, and conduct. I acknowledge that I have reviewed and that I understand all safety rules and other rules of use and participation at the TEN4. I hereby acknowledge that failure to follow any of these rules and policies may results in complete revocation of all privileges provided by the TEN4  without refund of any prepaid fees.

 

Acknowledgements to Promote Safety at TEN4:

These acknowledgements aid TEN4 in providing for your safety.

Health Status – I, on behalf of myself and, if applicable, my child or ward, assert that:

  • I and, if applicable, my child or ward, possess sufficient physical fitness and coordination to enable safe participation in TEN4 activities.
  • I and, if applicable, my child or ward, assume the risks of all medical conditions (e.g., asthma, diabetes, anaphylaxis, epilepsy, heart disease or high blood pressure).
  • TEN4 encourages you and, if applicable, your child or ward, to get medical clearance prior to participation.
  • I and, if applicable, my child or ward, will cease activity if there is discomfort (e.g., faintness, shortness of breath, high anxiety, or chest pains).

Emergency Care – I, on behalf of myself and, if applicable, my child or ward, assert that;

  • TEN4 can administer emergency first aid, CPR, and use an AED if deemed necessary.
  • TEN4 can secure emergency medical care or transportation (i.e. EMS) if deemed necessary.
  • I assume all costs of emergency medical care and transportation.

Rules & Safety – I, on behalf of myself and, if applicable, my child or ward, agree:

  • To abide by all safety-related rules while participating and inside the Freestyle premises.
  • To attempt only activities that each feels capable of performing safely.
  • To inform TEN4 immediately if I and, if applicable, my child or ward, see conduct or a facility condition that endangers others.
  • That I and, if applicable, my child or ward, understand the importance of safety rules and safety equipment.
  • That TEN4 has the authority to terminate participation if it is deemed a danger to others.

I have read the release and waiver of liability and fully understand its contents. I voluntarily agree to the terms and conditions stated.

I Agree
 

I will / have watched the safety induction video.

I Agree
 

Today's Date: November 30, 2022 

 

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*
Parent or Guardian's Email Address

Email*

Confirm Email*
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.


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*
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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