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                                                       Lake Macquarie Bushwalkers Inc.

                                                                                                                                      

                                                                        SAMPLE MEMBERSHIP APPLICATION AND RISK WAIVER FORMS

August 2013

New members MUST sign this document when joining the club.

In voluntarily participating in any activity of Lake Macquarie Bushwalkers Inc. I am aware that this may expose me to risk that could lead to injury, illness or death or to loss of or damage to my property.

Those risks may include but are not limited to slippery, and/or uneven surfaces, rocks being dislodged, falling at edges of cliffs or drops, elsewhere risks associated with crossing creeks, hypothermia and heat exhaustion.

To minimise these risks I will endeavour to ensure that any activity in which I participate is within my capabilities and that I am carrying food, water and equipment appropriate for the activity. I agree to advise the activity leader if I am taking any medication or have any physical or other limitations that might affect my participation in the activity.

I will make every effort to remain with the rest of the party during the activity and accept the instruction of the leader of the activity.

Lake Macquarie Bushwalkers Inc. has Public Liability Insurance. Please note and acknowledge the following Club Disclaimer regarding Insurance Excesses:

Claimants for Insurance Benefits from the Clubs’ Combined General & Products Liability Insurance Policy (Policy Number 408306) sourced from Bushwalking NSW Inc. should note that the Excess for this Policy is the responsibility of the Claimant for each and every Claim. Lake Macquarie Bushwalkers Inc. is not responsible for excess payments under any circumstances.

I have read or heard and understand these requirements; I have considered the risks before choosing to sign this form. I still wish to participate in the activities of Lake Macquarie Bushwalkers Inc. I agree by signing this form to waive any claim for damages arising from this activity that I may have against the club, the leader or other participants in tort or contract.

Have you any disabilities or medical problems that the Leader may need to know about? If so, please give details___________________________________________________________________

Name:        __________________________________

Address :   ____________________________________

                  ____________________________________

Post Code: _________

Phone No.:___________________ Mobile: ________________ E-mail ____________________

 

Current First Aid Certificate YES/NO

                                                 SAMPLE ONLY

I hereby consent/do not consent to my name, phone no & mobile no being distributed throughout the Club on a public list.

I hereby apply to become a member of Lake Macquarie Bushwalkers Inc. In the event of my admission as a member I agree to be bound by the Constitution of Lake Macquarie Bushwalkers Inc. for the time being in force.

Signature of Applicant______________________________Date______________________

I___________________________a member of the association nominate the applicant

Signature_______________________________________Date__________________________

I___________________________a member of the association second the nomination of the applicant for membership of the association.

Signature_______________________________________Date____________________________

 

Membership fee is $25.00 which is renewed annually.

                                                                                                                               

                                                                                          

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