Brisbane Catholic Bushwalking Club

(the Club)

Queensland

PO Box 31, Red Hill, Qld 4059

 

 

 

Acknowledgment of Risks and Obligations by Non-Members (Visitors)

 

I agree to participate in .......................... (the Activity)

Answer

YES or NO

 
on ...... / .../ 200.., an Activity of the Club.

 


 

 
I acknowledge that I am fully aware that my involvement in this Activity may
expose me to risks and dangers such that I could suffer injury, illness or death or
the loss of or damage to my property.

 

 

 
I warrant that this Activity is within my capabilities, and I am carrying sufficient
food, water and equipment that is appropriate for the Activity.

 

 

 
I warrant that I have advised the Activity leader of any medication that I am
taking or of any physical or other limitations that might affect my participation in
the Activity; and I will abide by the Club's decision on my ability to participate in
the Activity.

 

 

 
I will ensure that I make every effort to remain with the rest of the party during
the Activity.

 

 

 
I acknowledge that as a Visitor I am not covered by the Bushwalkers Public
Liability and Personal Accident Insurance Policies; and I acknowledge and accept
that the Club is not in any manner whatsoever responsible for any injuries or
damage that I may suffer as a result of participating in the Activity.

 

 

 
I have read and I understand these requirements.

 

Visitor's Full Name .............................................

Address

Phone Contact .. Mobile

 

Signed ........................... Date ........ / ..... / ...

 

Witness Date ... / . / ...

 

If the Participant is under the Age of 18, a Parent or Guardian must also Sign & Date
this form. This signifies the Parent or Guardian has understood the Risks &
Obligations, and agrees to accept them.

 

Parent/Guardian Signature:...... Date: ../../..

 

Activity Leader is to post/hand this form to the Secretary as soon as possible after the Activity.

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