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Shop 17/152 Musgrave Road
Red Hill, Brisbane
Queensland 4059
Australia

EXPRESS ASSUMPTION OF RISK, RELEASE OF LIABILITY AND INDEMNIFICATION 

The purpose of this document is to inform you of potential risks involved with rock climbing, abseiling and bouldering, the activities carried out by Highpoint Adventures Pty Ltd trading as ‘Pinnacle Sports’ (the Service Provider). The Service Provider has procedures and systems in place to ensure a safe and enjoyable experience for all participants, however, you are advised that rock climbing, abseiling and bouldering involve potential risks some of which are listed below.  

YOU ARE PARTICIPATING AT YOUR OWN RISK.BY SIGNING THIS DOCUMENT YOU WILL WAIVE CERTAIN LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE.

Express assumption of risk: I acknowledge that I am aware that there are significant risks involved in all aspects of rock climbing, abseiling and bouldering. These risks include, but are not limited to the following: falls from height; negligence on the part of myself, or other people around me; improper use or failure of equipment; the impact of natural elements such as rock fall or lightning; and heart attack, panic or hyperventilation in susceptible individuals due to the physically demanding nature of the activities. I am aware that any of these above mentioned risks may result in serious injury or death to me and or to other people around me.

I understand that should I feel light-headed, faint, dizzy, nauseous, or experience pain or discomfort, I am to stop the activity and inform the Service Provider. I willingly assume full responsibility for the risks that I am exposing myself to and accept full responsibility for any injury or death that may result from participation in any activity while under the supervision of the Service Provider. I am aware that this agreement is ongoing and will apply to all future occasions I participate in rock climbing, abseiling and bouldering under the supervision of the Service Provider. I acknowledge that I have no physical impairments, injuries, or illnesses that will endanger me or others. I acknowledge that I will listen carefully to directions and respect the advice of any person connected with the Service Provider.

Release: In consideration of the above mentioned risks and in consideration of the fact that I am willingly and voluntarily participating in the activities offered by the Service Provider, I release and indemnify the Service Provider, its principals, agents, employees and volunteers from any and all liability, claims, demands, actions or rights of action, which are related to, arise out of, or are in any way connected with my participation in this activity, including those allegedly attributed to the negligent acts or omissions of the above mentioned parties. This agreement shall be binding upon me, my successors, representatives, heirs, executors, assigns, or transferees. If any portion of this agreement is held invalid, I agree that the remainder of the agreement shall remain in full legal force and effect. I give permission for any person connected with the Service Provider to seek emergency medical services for me should I become injured or ill, with the understanding that I am responsible for any expense incurred. If I am signing on behalf of a participant under the age of 18, I also give permission for any person connected with the Service Provider to administer first aid deemed necessary, and in case of serious illness or injury, I give permission to call for medical and or surgical care for the participant and to transport the participant to a medical facility deemed necessary for the wellbeing of the participant.

Indemnification: I recognise that there is risk involved in the types of activities offered by the Service Provider. Therefore I accept financial responsibility for any injury that I may cause either to myself or to any other participant due to my negligence. Should the Service Provider, any person connected with the Service Provider, or anyone acting on their behalf, be required to incur legal fees and costs to enforce this agreement, I agree to reimburse them for such fees and costs. I further agree to indemnify and hold harmless the Service Provider, its principals, agents, employees and volunteers from liability for any injury or death of any person(s) (including myself) and damage to property that may result from my negligent or intentional act or omission while participating in activities offered by the Service Provider.

Photography/Video Release: Participants involved in any activities offered by the Service Provider may be photographed or videotaped while participating in such activities. I consent to the use of these photographs and/or videos without compensation, on the Service Provider’s website or in any editorial, promotional or advertising material produced and/or published by the Service Provider.

I have read and understood this express assumption of risk and release of liability and I understand that by signing it obligates me to indemnify the parties named for any liability for injury or death of any person and damage to property caused by my negligent or intentional act or omission. I understand that by signing this form I am waiving valuable legal rights.

Dated: May 25, 2018

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information

Details of any medical conditions (please list any condition which may affect your ability to participate in the proposed activity, e.g. medical condition, pregnancy, illness, disability or allergy eg bee stings).*

Participant Residential Address*

Emergency Contact Name:*

Emergency Contact Phone Number:*
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*

Phone*
Second Participant's Date of Birth*
Second Participant's Information

Details of any medical conditions (please list any condition which may affect your ability to participate in the proposed activity, e.g. medical condition, pregnancy, illness, disability or allergy eg bee stings).*

Participant Residential Address*

Emergency Contact Name:*

Emergency Contact Phone Number:*
Third Participant's Name

First Name*

Last Name*

Phone*
Third Participant's Date of Birth*
Third Participant's Information

Details of any medical conditions (please list any condition which may affect your ability to participate in the proposed activity, e.g. medical condition, pregnancy, illness, disability or allergy eg bee stings).*

Participant Residential Address*

Emergency Contact Name:*

Emergency Contact Phone Number:*
Fourth Participant's Name

First Name*

Last Name*

Phone*
Fourth Participant's Date of Birth*
Fourth Participant's Information

Details of any medical conditions (please list any condition which may affect your ability to participate in the proposed activity, e.g. medical condition, pregnancy, illness, disability or allergy eg bee stings).*

Participant Residential Address*

Emergency Contact Name:*

Emergency Contact Phone Number:*
Fifth Participant's Name

First Name*

Last Name*

Phone*
Fifth Participant's Date of Birth*
Fifth Participant's Information

Details of any medical conditions (please list any condition which may affect your ability to participate in the proposed activity, e.g. medical condition, pregnancy, illness, disability or allergy eg bee stings).*

Participant Residential Address*

Emergency Contact Name:*

Emergency Contact Phone Number:*
Sixth Participant's Name

First Name*

Last Name*

Phone*
Sixth Participant's Date of Birth*
Sixth Participant's Information

Details of any medical conditions (please list any condition which may affect your ability to participate in the proposed activity, e.g. medical condition, pregnancy, illness, disability or allergy eg bee stings).*

Participant Residential Address*

Emergency Contact Name:*

Emergency Contact Phone Number:*
Seventh Participant's Name

First Name*

Last Name*

Phone*
Seventh Participant's Date of Birth*
Seventh Participant's Information

Details of any medical conditions (please list any condition which may affect your ability to participate in the proposed activity, e.g. medical condition, pregnancy, illness, disability or allergy eg bee stings).*

Participant Residential Address*

Emergency Contact Name:*

Emergency Contact Phone Number:*
Eighth Participant's Name

First Name*

Last Name*

Phone*
Eighth Participant's Date of Birth*
Eighth Participant's Information

Details of any medical conditions (please list any condition which may affect your ability to participate in the proposed activity, e.g. medical condition, pregnancy, illness, disability or allergy eg bee stings).*

Participant Residential Address*

Emergency Contact Name:*

Emergency Contact Phone Number:*
Ninth Participant's Name

First Name*

Last Name*

Phone*
Ninth Participant's Date of Birth*
Ninth Participant's Information

Details of any medical conditions (please list any condition which may affect your ability to participate in the proposed activity, e.g. medical condition, pregnancy, illness, disability or allergy eg bee stings).*

Participant Residential Address*

Emergency Contact Name:*

Emergency Contact Phone Number:*
Tenth Participant's Name

First Name*

Last Name*

Phone*
Tenth Participant's Date of Birth*
Tenth Participant's Information

Details of any medical conditions (please list any condition which may affect your ability to participate in the proposed activity, e.g. medical condition, pregnancy, illness, disability or allergy eg bee stings).*

Participant Residential Address*

Emergency Contact Name:*

Emergency Contact Phone Number:*
11 Participant's Name

First Name*

Last Name*

Phone*
11 Participant's Date of Birth*
11 Participant's Information

Details of any medical conditions (please list any condition which may affect your ability to participate in the proposed activity, e.g. medical condition, pregnancy, illness, disability or allergy eg bee stings).*

Participant Residential Address*

Emergency Contact Name:*

Emergency Contact Phone Number:*
Parent or Legal Guardian's Details Email Address

Email*

Confirm Email*
Check the box to receive marketing material. (ie. awesome deals on climbing gear, courses, training, bouldering festivals, overseas climbing trips and all the latest news from the Pinnacle Ambassadors)
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Legal Guardian's Details Name

First Name*

Last Name*

Relationship*

Phone*
Parent or Legal Guardian's Details Date of Birth*
Parent or Legal Guardian's Details Information

Details of any medical conditions (please list any condition which may affect your ability to participate in the proposed activity, e.g. medical condition, pregnancy, illness, disability or allergy eg bee stings).*

Participant Residential Address*

Emergency Contact Name:*

Emergency Contact Phone Number:*
Parent or Legal Guardian's Details Signature
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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