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Application
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2024-08-01T11:47:05+00:00
APPLICATION FORM
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First Name
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Last Name
*
Date of birth
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Street Address
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Suburb
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Postcode
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Telephone Number
Mobile
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Emergency
Email
*
Where did you hear about Power Gymnasium?
Gender
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Male
Female
Gym Location
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Brunswick
Medical Information
Please list and advise Power Gymnasium of any Medical Conditions, Medications and/or Injuries
Terms & Conditions
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I agree to the Terms & Conditions
Acknowledgement of Risks, Injury and Obligations
I acknowledge that the activities I am to undertake have potential dangers and by participating in them I am exposed to certain risks.
I acknowledge and understand that whilst participating in any such activities:
I may be injured physically, mentally or may die.
Any physical conditions I may have of which I may or may not be aware of, of which I may or may not have disclosed to Power Gymnasium or its staff, may be aggravated or worsened by my participation.
My personal property may be lost or damaged.
Other persons participating in such activities may cause me injury or may damage my property.
I may cause injury to other persons or damage their property.
The conditions in which activities are conducted may vary without warning.
I may be injured or die or suffer damage to my property as a result of the negligence or breach of contract of Power Gymnasium, its servants or agents.
There may be no or inadequate facilities for treatment or transport if I am injured.
I assume the risk of, and the responsibility for any injury, illness, death or property resulting from my participation in any activities.
Release and Indemnity to Power Gymnasium
In consideration of the acceptance of my payment (or guest status) for participating in any activity (and except to the extent that Power Gymnasium may be precluded by statute) I agree to release and indemnify Power Play Gym and staff as follows:
I participate in the activities at my sole risk and responsibility.
I release, indemnify and hold harmless Power Gymnasium its servants and agents, from and against all and any actions or claims which may be by me or by other parties for in respect of arising out of injury loss, damage or death caused to me or my property whether by negligence, breach of contract or in any way what so ever.
I also agree that in the event that I am injured or my property is lost or damaged, I will bring no claim, legal or otherwise, against Power Gymnasium or its servants and agents, in respect of that injury, loss or damage. Before signing this document I have read and understand and know how it affects my legal rights.
When the Participants are under 18 Years of age.
I, being a parent or legal guardian of the person named in this acknowledgement and release hereby acknowledge and agree:
I have read the whole document and understand it. I consent to the person, named in this acknowledgement and release, participating in the activity and I am aware of the risks, dangers and obligations set out above in this acknowledgement and release.
In consideration of the person named in this acknowledgement and release being accepted to participate in any activity I agree to release and indemnify Power Gymnasium or its servants and agents, in the same manner and to the same effect and extent as I were the person first named in this acknowledgement and release and the person participating in any of the activities.
Signature
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