Under 18 Consent and Release of Indemnity Form 5 South Dr, Bentleigh East VIC 3165 Waiver Form Riders Details Name(Required) First Last Adress(Required) Age(Required) Gender Child(Required)MaleFemaleParent/Guardian Name:(Required) Relationship to Child:(Required) Contact No:(Required) Email:(Required) Mobile No:(Required)Alternative Contact Person: Contact No Alternative: Date of first visit:(Required) Purpose of visit:(Required) Birthday attending (if applicable): DeclarationThis Consent and Registration form is to be completed by the Parent/Guardian. This form must be fully completed and returned to Bike Skills so as to allow the participant to participate in the training course.Consent Agreement(Required) I have carefully read this Consent Form in its entirety and agree to be bound by the terms printed on the back page of this Consent Form. I acknowledge and accept that the sport of cycling carries a degree of risk of injury. Instructor Compliance(Required) I agree to obey to all the rules, directions and decisions of my Bike Skills Instructor and Officials whilst participating in the program. Parental Consent(Required) I have read this Consent Form in its entirety and agree to the Conditions for my child’s participation in the Bike Skills Program. I declare that I am authorised to accept the conditions set out in this Consent Form as the parent/legal guardian of the named participant. Medical Authorization(Required) I hereby authorise Bike Skills to act on my behalf should my child require medical attention, and release Bike Skills from any liability for any injury incurred by my child at cycle training programs conducted by Bike Skills. Please note all data collected is confidential and for evaluation purposes only.Health Warranty(Required) I warrant that I am in good physical condition and have no medical condition, complaint, impairment or ailment that will prevent me from participating in the Bike Skills Training Program or that will be detrimental to my health, safety or physical condition, or the health, safety or physical condition of others while participating in a Bike Skills Training Program or while at or near the Program. Release and indemnity:Liability Release(Required) I hereby release and forever discharge Bike Skills, and their officers, directors, employees, agents and contractors and sponsors, from any and all claims, suits, demands, expenses, costs, actions and proceedings of any nature whatsoever including negligence, which I, my executors or administrators or any other person has or might assert against any of them arising from, in relation to, incidental to or by virtue of any injury, loss or damage suffered or sustained in connection with participation in the Bike Skills Cycling Training course or at any time when near the Bike Skills Cycling Training course. I hereby indemnify and hold harmless, and shall keep indemnified and held harmless, Bike Skills, their officers, directors, agents, contractors and sponsors from and against all claims, suits, demands, expenses, costs, actions and proceedings of any nature whatsoever arising from, in relation to or by virtue of: (1) Any injury, loss or damage sustained by me. (2) Any injury, loss or damage suffered by any other person as a result of any act, omission, neglect or default on my part, in connection with my participation in the Bike Skills Cycling Training course at any time when I amnear the Bike Skills Cycling Training course. I agree to wear an Australian Standards approved cycling helmet whilst riding a bike at all times during this period. I agree that I am responsible formy personal accident insurance, ambulance cover and any medical costs not covered by Bike Skills’ insurance Δ
