WAIVER RELEASE & INDEMNITY DEED
To: Emma Carney Training Pty Ltd ACN 160 928 405 of PO Box 466 East Melbourne 8002 (including its directors, employees, agents and independent contractors) (collectively and severally referred to as 'Emma Carney').
In consideration of Emma Carney permitting me to participate in Emma Carney's training, including but not limited to, running, cycling and swimming activities (including instruction in any of these activities) (collectively and severally referred to as 'Triathlon Training')
I, (Name) ...... Born: / / of
Address: ...... City: ...... State: ......
agree as follows:
Emma Carney Training Pty Ltd Waiver Release and Indemnity Deed Page 1 of 1 November 2014
1. Express Acceptance of Risk
a) I confirm that the answers I have provided in this form are true and correct and that Emma Carney has relied on those answers in allowing me to participate in the Triathlon Training.
b) I personally and voluntarily assume all the risks for any harm, trauma, injury or damage that I may suffer to my person or my property whether foreseen or unforeseen in connection with the Triathlon Training.
c) I certify to Emma Carney that I have no pre-existing physical conditions or mental impairment that would restrict my ability to participate in the Triathlon Training or would be affected by such participation other than those medical conditions listed below. (Please detail any pre-existing medical conditions): ______
______
d) I certify that I have been advised of the inherent risks associated with the Triathlon Training and I voluntarily choose to participate in the Triathlon Training fully accepting such risks, should they arise, may cause personal injury, death or property damage and in particular I acknowledge that I have been advised that:
i. Triathlon Training is physically demanding and involves certain risks and injuries, including but, not limited to:
A. stress on joints, ligaments and tendons;
B. skeletal injuries such as shin splints, bone fractures, bones chips and breaks;
C. muscle injuries to upper and lower body;
D. fall or impact injuries, particularly during cycling training;
E. water-related risks such as hypothermia, drowning;
F. equipment malfunction risks;
G. exposure to harmful weather conditions such as storm, wind, tide, sun and rain;
H. injury whilst being in proximity to the site where the Triathlon Training is being conducted;
I. outdoor hazards such as slippery roads, rough terrain and traffic hazards during training; and
that such injuries / risks may result in personal injury, death or property damage;
ii. the injuries of the type referred to in this clause 1.d) may require medical treatment;
iii. Emma Carney is not a medical practitioner and cannot provide advice as medical practitioners;
iv. I should seek medical advice from a medical practitioner prior to participation in the Triathlon Training;
v. the Triathlon Training may be conducted at a location that is remote either in time and/or distance from a medical treatment facility;
vi. it is my responsibility to obtain adequate insurance to ensure that I am covered for any loss or damage, personal injury, death, judgements, cost of litigation, attorney fees, economic loss or consequential loss arising as a result of my participation in the Triathlon Training or related activities.
2. Release Discharge & Indemnity
a) I unconditionally release, discharge and indemnify Emma Carney from all liabilities, claims and causes of action that may arise from any act, omission, default, failure or error on the part of Emma Carney (including any negligent act, omission, default, failure or error) occurring wholly or partially during the course of the Triathlon Training.
b) I agree that Emma Carney will not be liable for and waive any right to claim any loss or damage, personal injury, death, judgements, cost of litigation, attorney fees, economic loss or consequential loss whether in tort, in contract, under statute or otherwise, for any default, failure, negligence or error on the part of Emma Carney.
c) If, despite these terms, it is found that Emma Carney is liable to compensate me then such liability is limited to the cost of providing the service in respect of which the liability arises.
3. Statement of Understanding
a) I acknowledge that I have read and understood the matters set out in this and that I am of lawful age and legally competent to give this waiver, release and indemnity.
b) I acknowledge that the conditions set out in this document are contractual in nature, are intended to have legal effect and are not merely a warning or recital.
c) I have signed this document of my own free will and without any representation or inducement by Emma Carney, its agents or employees.
Emma Carney Training Pty Ltd Waiver Release and Indemnity Deed Page 1 of 1 November 2014
DO NOT SIGN THIS DOCUMENT UNLESS YOU HAVE READ IT AND UNDERSTOOD ITS TERMS AND CONDITIONS. BY SIGNING THIS AGREEMENT, YOU ASSUME ALL RISKS AND AGREE TO WAIVE YOUR LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE.
Emma Carney Sport Pty Ltd Waiver Release and Indemnity Deed Page 2 of 2 June 2008
Executed as a Deed. Date of Deed: ...... Day of ...... 200 ......
SIGNED SEALED & DELIVERED, by the said:Name: ......
Signature: ...... / Parent/Guardian if participant is under 18
Name: ......
Signature: ......
Participants under the age of 18 at time of registration must also have a Parent / Guardian sign above. Where this form is signed by the parent or guardian of a minor (being a person under the age of 18 years) then the parent/guardian warrants that the information contained in this form is true and correct and personally covenants in terms of this waiver, release and indemnity.
In the presence of:
Witness Full Name: ...... (Print name of Witness) Signature: ...... (Signature of Witness)
Emma Carney Sport Pty Ltd Waiver Release and Indemnity Deed Page 2 of 2 June 2008