LIABILITY & ASSUMPTION OF RISK WAIVER
(Iluka Retreat Pty Ltd)
Camp Date:
Participant Name:________________________________
School Name:
Guardian Name: Ph:
Contact Email:
Declaration
Please acknowledge and tick that you agree and understand the declaration and indemnity below:
I understand that the camp program/ activities may contain and is not be limited to outdoor adventurous activities such as high and low rope courses; water activities; canoeing and swimming; biking; bushwalking, hiking and navigating; camping; meal preparation and open flame cooking; beach activities; and games
I understand the inherent risks of this program and give permission for the Participant/s to partake.
I understand that while all appropriate precautions will be taken, the program activities carry an inherent element of risk.
I have made myself fully aware of the risks and have requested additional information or clarification if I am not fully satisfied, before agreeing to this Declaration and Indemnity.
I hereby give my consent and authorize the person/s in charge, or his/her representatives, to administer medical attention for the Participant/s as may be deemed necessary during the program, and I understand I am responsible for any costs resulting therefrom.
I understand that by choosing to participate, or granting approval to participate, in the program I agree to indemnify Iluka Retreat Pty Ltd against claims for personal injuries that may result from my participation or involvement except to the extent that such injury was caused, or contributed to, by a negligent or wilful act or omission of Iluka Retreat Pty Ltd, its agents and its employees.
This Declaration and Indemnity states that, where necessary, I have sought satisfactory clarification from the Iluka Retreat Pty Ltd about the inherent risks associated with the program and its activities and I understand and accept those risks. I understand that this Declaration and Indemnity will be retained and stored in accordance with Privacy Legislation; that the information will be used only to facilitate the provision of a safe and enjoyable experience for the program Participants; that the Participant may update incorrect information, or inspect information held about them by The Company at any agreed time.
Notwithstanding any other clause in this Declaration and Indemnity, and for the avoidance of doubt, nothing in this Declaration and Indemnity is to be construed as releasing, indemnifying, limiting or discharging Illuka Retreat Pty Ltd and/or their directors, officers, servants, agents, invitees, or contractors (Personnel) from any liability caused or contributed to by Illuka Retreat Pty Ltd and/or their Personnel’s negligent or wilful acts or omissions. This clause will prevail to the extent of any inconsistency with any other clause in this Declaration and Indemnity.
I understand that should I refuse to provide a Declaration and Indemnity the Participant will most likely be refused permission to participate in the program. I agree to contact the Company on +61 59898505 / 0409032877 if I do not fully understand and agree with this Declaration and Indemnity.
Guardian Signature ____ Date: __________
Iluka Retreat Pty Ltd
Group Accommodation & School Camps & Programs
Address: 20 Shoreham Rd, Shoreham, VIC 3916 Ph: 03 59898505 www.ilukaretreat.com.au