ORGANISER:
REGISTRATION FOR:	[Enter Name of Event here]
LOCATION:
EVENT DATE:
PARTICIPANT DETAILS
Name (please print):	PaddleNSW Member No:
Address:
Suburb:	State:	Country:
D.O.B ……… / ……….. / ………	Email (primary):
Phone (Incl area code): Home	Work	Mobile:
Swimming Ability (please circle answer). Can you swim?	Yes / No
Medical Notes: Do you have any medical condition that the Event Co-ordinator needs to be informed about? (e.g., asthma, epilepsy, heart condition, allergies, motion sickness, water phobias, other?) If yes, please provide details: ……………………………………………………………………………………………………	Yes / No
EMERGENCY CONTACT DETAILS
Name (please print):	Relationship:
Phone (Incl area code): Home	Work	Mobile:
PARENT/GUARDIAN
Name (please print):
Address:
Suburb:	State:	Country:
Phone (incl area code): Home	Work:	Mobile:

DISCLAIMER / WAIVER

I/we understand that outdoor recreation programs: kayaking and swimming included, inherently involve some risks. I/we will not hold NAME OF ORGANISER, its staff and volunteers liable for any personal loss or injury sustained or damage to personal property during any of our events. I/we give permission for First Aid to be administered by qualified staff (min Senior First Aid certificate and/or Certificate II in Public Safety and Aquatic Rescue) when deemed necessary. All information about me and provided by me on the preceding page is true and correct.

TERMS & CONDITIONS

Health Information:

By signing this form you certify that you do not have any physical conditions or disabilities that would create a hazard for you or other participants. NAME OF ORGANISER will reserve the right to decline your participation should your health, actions or general deportment impede the operation of the event, or the rights, welfare and enjoyment of other participants.

Responsibility:

Whilst we do our best to provide a safe and enjoyable experience NAME OF ORGANISER, its staff, volunteers and associates (including local council) shall not be held responsible for any liability of property loss or damage and / or damages resulting from illness, personal injuries or death which may be sustained while engaged in our event. NAME OF ORGANISER will not be held responsible for any personal injury, damage or loss to property arising out of civil disturbances, weather, or Acts of God during our event. Your safety and enjoyment are our number one priority.

I understand that this event is sanctioned under the “Paddling Australia Events” certification process provided by Australian Canoeing, and provides me with public liability insurance cover during the event.

I agree that my personal details contained in the event registration process can be made available to AC for the purpose of maintaining a database of insured persons and for other promotional purposes.

Wearing a PFD/life jacket and appropriate footwear is compulsory and I agree to comply with this condition.

I have read and understood the Disclaimer/Waiver and these Terms & Conditions

_____________________________________________	______________________________________________

SIGNATURE	DATE

IMPORTANT: Any person under 18 years of age must have a parent or guardian sign on their behalf.

Terms and Conditions

I hereby apply for entry to the Event Promoter - Paddling Australia event known as ‘Name of Event’ (Event) to be held on ‘Date of Event’, at ‘Location of Event’. In so applying and in consideration of this application for participation in the Event being accepted on I acknowledge and agree that:

1.	In this application:

"Event Activities" means performing or participating in any capacity in the Event.

“Event Promoter” means Event Promoter, the event organiser/organisation named on the Maritime Licence for this event.

"Australian Canoeing" or "AC" means Australian Canoeing Incorporated.

"Canoeing Organisations” means and includes Australian Canoeing, Queensland Canoeing Incorporated and any other canoeing organisation or event organiser involved in the organisation or conduct of the Event and where the context so permits, their respective directors, officers, members, servants or agents.

2.	If accepted I will be permitted to participate in the Event subject to my complying with the terms and conditions of the Event, this declaration and any reasonable direction issued by the Event organisers or their representatives.

3.	This document cannot be amended. If I do amend it my application will be null and void. It cannot be accepted by AC.

4.	Insurance is in place that provides limited cover to me whilst I am participating in the Event. (For insurance details contact info@canoe.org.au). I understand that this insurance may not cover me for all injury, loss or damage sustained by me and I can, in my own interests, seek and obtain personal insurances over and above the cover provided by AC.

5.	The Event rules and this declaration comprise a contract between the Event Promoter, Australian Canoeing and myself. It is necessary and reasonable for promoting and conducting the Event.

6.	Warning: Participation in the Event can be inherently dangerous. I acknowledge that I am exposed to certain risks during the Event including but not limited to overexertion, equipment failure, dehydration, serious accidents, and weather conditions. I acknowledge that accidents can and often do happen which may result in me being injured or even killed, or my property being damaged. I have voluntarily read and understood this warning and accept and assume the inherent risks in participating in the Event.

7.	Compulsory personal safety equipment: I agree to wear a personal flotation device, safety leash and footwear at all times during the event.

8.	Exclusion of Implied Terms: 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 the Canoeing Organisations (or any of them) flowing from them, are expressly excluded to the extent possible by law, by this event application and declaration. To the extent of any liability arising, the liability of the Canoeing Organisations will, at the discretion of the relevant Canoeing Organisations, 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.

9.	Release and Indemnity: In consideration of AC accepting my application for participation into the Event I, to the extent permitted by law:

(a)	release and will release the Canoeing Organisations 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 Event; and

(b)	indemnify and will keep indemnified the Canoeing Organisations in respect of any Claim by any person arising as a result of or in connection with my membership and/or participation in the Event.

In this clause 8 “Claims” means and includes any action, suit, proceeding, claim, demand, damage, penalty, cost or expense however arising but does not include a claim in respect of any action, suit, etc made by any person entitled to make a claim under a relevant Event insurance policy.

10.	Fitness to Participate: I declare that I am and must continue to be medically and physically fit and able to participate in the Event. I am not and must not be a danger to myself or to the health and safety of others. I will immediately notify the event promoter or AC in writing of any change to my fitness and ability to participate. I understand and accept that the event promoter and AC will continue to rely upon this declaration as evidence of my fitness and ability to participate.

11.	Privacy: I understand that the information I have provided is necessary for the conduct of the Event and for the Objects of AC. I acknowledge and agree that the information will only be used by the Event Promoter and the Canoeing Organisations to facilitate the conduct of the Event and other Events conducted by the Event Promoter and the Canoeing Organisations. I understand that I will be able to access my information through the Event Promoter, AC or a Canoeing Organisation. If the information is not provided my application may be rejected. I acknowledge that the Canoeing Organisations may also use my personal information in accordance with the AC Privacy By-law. I may advise AC if I do not wish to receive from AC any AC sponsors or third parties’ promotional material.

12.	Copyright and right to use image: I acknowledge and consent to photographs and electronic images being taken of me during my participation in the Event. I acknowledge and agree that such photographs and electronic images are owned by AC and that the Event Promoter and Canoeing Organisations may use the photographs for promotional or other purposes without my further consent being obtained. Further, I consent to the Event Promoter and Canoeing Organisations using my name, image, likeness and also my performance in the Event, at any time, to promote the Event by any form of media.

13.	Consent to medical treatment: I consent to receiving any medical treatment that the Event organisers or their authorised representatives consider necessary or desirable during or after the Event. I also agree to reimburse Event Promoter the relevant Canoeing Organisation for any costs or expenses incurred in providing me with medical treatment. I understand that I am provided with limited personal accident insurance for the duration on this event.

14.	Prevailing conditions: The Event and the conduct of, and participation in the Event will be affected by weather and associated conditions. Given there is often an element of the “luck of the prevailing conditions” in participating and/or competing in the Event I acknowledge and agree the Event organisers cannot control the weather and associated conditions.

15.	Severance: If any provision of this application and declaration is invalid or unenforceable in any jurisdiction, the phrase or clause is to be read down for the purpose of that jurisdiction, if possible, so as to be valid and enforceable. If the phrase or clause cannot be so read down it will be severed to the extent of the invalidity or unenforceability. Such severance does not affect the remaining provisions of this application and declaration or affect the validity or enforceability of it in any other jurisdiction.

16.	I have provided the information required in this application and declaration and acknowledged this declaration below. I warrant that all information provided is true and correct. I have read, understood, acknowledge and agree to the above terms including the warning, exclusion of implied terms, release and indemnity.

Signed _____________________________ Name _________________________________ Date: ___________________

Where the applicant is under 18 years of age this form must also be signed by the applican’t parent or legal guardian.

I am the parent or guardian of the applicant. I expressly agree to be responsible for the applicant’s behaviour and agree to personally accept the conditions set out in this application and declaration including the provision by me of a release and indemnity in the terms set out above.

Parent’s/Guardian Signed ___________________________ Name ___________________________ Date: ____________

(where the applicant is under 18 years of age)