2nd Emergency Contact

Name

Telephone/Mobile*

Email Address

Relationship

AUTHORISATIONS*

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I understand that participating in physical activity carries a risk and I accept all responsibility for that risk.
I authorise Gooromon Park Staff to obtain, at my cost, medical or ambulance assistance in the case of an accident or emergency
I agree that Gooromon Park accepts no liability, financial or otherwise, for any injuries or accidents that occur.
I give permission for Gooromon Park Staff photographing or videoing during there time at the Gooromon Park and acknowledge these photos could be used for promotional purposes by Gooromon Park or there affiliates
I give permission for Gooromon Park to communicate events, specials for promotional purposes

VACCINATION STATUS*

The Rider is over 16yrs of age is fully vaccinated.
The Rider is over 16yrs of age, is NOT fully vaccinated, will be accompanied by a fully vaccinated parent at all times.
The Rider is under 16yrs of age.

As a business located in NSW, we are required to ensure all people over the age of 16 who visit our premises are fully vaccinated. A person who is over 16 years of age who is not fully vaccinated should not be on the premises. Any person who is under 16 years old and is not fully vaccinated is only on the premises if they are accompanied by a fully vaccinated member of their household or they are on the premises for work. These rules apply to staff at business premises as well as customers.

Disclaimer

ACKNOWLEDGEMENT*

I/Parent/Guardian of the above named attending Gooromon Park Horse Riding Centre acknowledge that I understand that while all precautions are taken to ensure the safety of those attending the Centre and while every care will be exercised, the proprietors and their employees and agents are not liable in any way for any accident or damage which may occur or happen from any cause whatsoever and the above named person, whether participating in any of the activities of Gooromon Park or not, will do so only at my/his/her OWN RISK. On this basis the Signaturee/Parent/Guardian, by sign- ing this form, agrees to indemnify the proprietors and their employees and agents against any claim or demand whatsoev- er made for or on behalf of the above named person or in respect of any horse or property owned or used by the above named person. I confirm that I have read the whole of this document and have taken all necessary actions to ensure I am aware that HORSE RIDING IS A DANGEROUS ACTIVITY and consent to my/ him/ her participating in all activities at Gooromon Park, I acknowledge that equestrian activities are dangerous and that accidents causing death, bodily injury, disability and property damage can and do happen.

MEDICAL/DISABILITY/BEHAVIOURAL CONDITIONS*

YES
NO

Please disclose all medical/disabilities/behavioural conditions, as it is of the utmost importance that our staff totally understand those in their care.

Description

CANCELLATIONS POLICY*

24hrs notice must be given if a lesson is cancelled or re-scheduled. **If notice is not given 24 hrs in advance a lesson fee is charged. NO REFUNDS are given if a person is unable to continue due to an accident or ill health or declines to attend all or part of the paid program.

MAKE-UP LESSON POLICY*

One Lesson may be made up provided the above procedure is followed and only if a 10 week term program has been paid.

Date*

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GOOROMON PARK DISCLAIMER FORM

2nd Emergency Contact

Disclaimer