High Ropes Course Waiver and Disclosure

SWELL - HIGH ROPES COURSE

WAIVER AND DISCLOSURE

Belgravia Health and Leisure Group Pty Ltd (‘Belgravia’) ACN 005 087 463 t/as ”SWELL Palmerston”

As a condition of my participation in the High Rope Course at SWELL Palmerston (the ‘Course’), I acknowledge and agree as follow:

*Participants under 18 years old must have a parent/guardian also acknowledge and agree on their behalf.:

Rules of participation

1. I agree to follow any rules, directions and instructions given or set out by Belgravia (or its agents) in connection with the Course (the Rules) and acknowledge that if I fail to comply with the Rules I will not be permitted to participate or to continue to participate in the Course. Participation Rules include:

a. Participants must

i. be:

at least 122cm tall;
weigh less than 135kg;
in attendance for the entirety of the safety briefing prior to the Course;

ii. sign this waiver or have their parent/guardian do so on their behalf prior to the Course;

iii. consent to physical contact from the Course staff to enable harnessing to occur prior to commencing the Course and clipping on an off throughout the course if required.

iv. behave at all times in a courteous and respectful manner towards Belgravia staff;

v. Comply with the Rules throughout the Course.

b. Participants that do not arrive in time to participate in the safety briefing or whom otherwise fail to comply with the above participation rules will be denied entry to the Course or escorted from the Course if already commenced.

c. Each session shall be capped at a maximum of 15 Participants.

d. Belgravia reserves the right to modify and supplement the Rules from time to time and publish further or additional Rules in respect to the Course.

Course Risk Warning

2. I acknowledge that:

a. the Course is inherently dangerous and involves risks, including (but not limited to) undertaking an activity at heights;

b. not all risks can be foreseen or controlled;

c. accidents can happen and by participating in the Course I may face harm including personal injury, property damage or death.

Waiver

3. I agree and undertake any risk associated with my use of the Course voluntarily and at my own risk.

4. I acknowledge that the assumption of risk and the Course Risk Warning above constitutes a 'risk warning' in accordance with relevant legislation.

5. As a supplier of recreational services Belgravia may ask me to agree that the statutory guarantees under the Australian Consumer Law in Schedule 2 to the Competition and Consumer Act 2010 (Cth) (ACL) do not apply to me (or a person for whom or on whose behalf I am acquiring the services or activities). Full ACL is available at legislation.gov.au

6. By signing this declaration, I acknowledge that where I am a consumer of recreational services, as defined by any relevant law, certain terms and rights usually implied into a contract for the supply of goods or services may be excluded. I acknowledge that these implied terms and rights and any liability of Belgravia flowing from them, are expressly excluded to the extent possible by law, by this High Ropes Course Waiver and Disclosure form and declaration. To the extent of any liability arising, the liability of Belgravia will, at the discretion of Belgravia, be limited in the case of goods, to the replacement, repair or payment of the cost of replacing the goods and in the case of services, the resupply of the services or payment of the cost of having the services supplied again. For the avoidance of doubt, this exclusion does not exclude liability for recklessness as defined by any relevant law.

Release and indemnity

7. Save that the below releases and indemnities shall not apply to the extent that the loss, damage or injury that is the subject of the Claim is caused or contributed to by the gross negligence of Belgravia, I:

a. release and will release Belgravia from all Claims that I may have or may have had but for this release arising from or in connection with my participation in the Course; and

b. release and indemnify Belgravia against any Claim which may be made by me or on my behalf for or in respect of or arising out of my death whether caused by the negligence or breach of contract by Belgravia or in any other manner whatsoever; and

c. indemnify and will keep indemnified Belgravia to the extent permitted by law in respect of any Claim by any person:

i. arising as a result of or in connection with my participation in the Course;

ii. against Belgravia in respect of any injury, loss or damage arising out of or in connection with my failure to comply with Belgravia's Rules and/or directions.

Claim means and includes any action, suit, proceeding, claim, demand, damage, penalty, cost or expense however arising including but not limited to negligence, (but not gross negligence) by any person expressly entitled to make a claim under any applicable insurance policy.

Disclosure of Medical Conditions and Fitness to Participate

8. I warrant that prior to participating in the Course I am and must continue to be medically, mentally and physically fit and able to undertake and participate in the Course. I acknowledge that Belgravia relies on information provided by me and that all such information is accurate and complete.

Privacy

9. I have provided personal information to Belgravia. This information is collected and may be used in accordance with Belgravia’s Privacy Policy (available at https://www.swellpalmerston.com.au/).

I have read, understood, acknowledge and agree to the above terms including the risk warning, exclusion of implied terms, release and indemnity.

I warrant that all information provided is true and correct. I acknowledge this application and declaration cannot be amended. If I do amend it my application will be null and void and cannot be accepted by Belgravia. I have read, understood, acknowledge and agree to the above terms including the risk warning, exclusion of implied terms, release and indemnity.

Today's date: May 12, 2024

Please select who will be participating...

Adult Minor(s)Adult and Minor(s)
1 Minor 2 Minors 3 Minors 4 Minors 5 Minors More Minors 6 Minors 7 Minors 8 Minors 9 Minors 10 Minors

Continue

First Participant's Name

First Name*

Middle Name

Last Name*

Phone*

First Participant's Date of Birth*

First Participant's Information

Age:

Medical Conditions:

First Participant's Signature*

Type Signature

Draw Signature

Click to Sign

Second Participant's Name

First Name*

Middle Name

Last Name*

Second Participant's Date of Birth*

Second Participant's Information

Age:

Medical Conditions:

Third Participant's Name

First Name*

Middle Name

Last Name*

Third Participant's Date of Birth*

Third Participant's Information

Age:

Medical Conditions:

Fourth Participant's Name

First Name*

Middle Name

Last Name*

Fourth Participant's Date of Birth*

Fourth Participant's Information

Age:

Medical Conditions:

Fifth Participant's Name

First Name*

Middle Name

Last Name*

Fifth Participant's Date of Birth*

Fifth Participant's Information

Age:

Medical Conditions:

Sixth Participant's Name

First Name*

Middle Name

Last Name*

Sixth Participant's Date of Birth*

Sixth Participant's Information

Age:

Medical Conditions:

Seventh Participant's Name

First Name*

Middle Name

Last Name*

Seventh Participant's Date of Birth*

Seventh Participant's Information

Age:

Medical Conditions:

Eighth Participant's Name

First Name*

Middle Name

Last Name*

Eighth Participant's Date of Birth*

Eighth Participant's Information

Age:

Medical Conditions:

Ninth Participant's Name

First Name*

Middle Name

Last Name*

Ninth Participant's Date of Birth*

Ninth Participant's Information

Age:

Medical Conditions:

Tenth Participant's Name

First Name*

Middle Name

Last Name*

Tenth Participant's Date of Birth*

Tenth Participant's Information

Age:

Medical Conditions:

Parent or Guardian's Email Address

Email*

Confirm Email*

Check to receive information, news, and discounts by e-mail.

Participant's 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:*

Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*

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.

PARTICIPANTS UNDER 18 YEARS:

I, , the parent or guardian of the participant, authorize and consent to their participation in the Course. I expressly agree to be responsible for the participant’s behaviour and agree to accept in my capacity as parent or guardian, the terms set out in this declaration, including the risk warning, exclusion of implied terms and provision by me of a release and indemnity in the terms set out above.

PARTICIPANTS UNDER 18 YEARS:

Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Phone*

Parent or Guardian's Date of Birth*

Parent or Guardian's Information

Age:

Medical Conditions:

Parent or Guardian's Signature*

Type Signature

Draw Signature

Click to Sign

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.

One or more problems exist. Please scroll up.

Agree To This Document

Smartwaiver - TRY IT FREE!