Kids After School Activity Booking Form

Thank you for booking a session for the Kids Obstacle Club ‘After School Club’.

We can’t wait for your child to join us at the club. In order to complete your booking we need you to complete the following form once you have read the disclaimer below.

DISCLAIMER

I hereby understand and agree by submitting this form that I have read, understand and agree to all clauses in the disclaimer.


Session Details


PAR-Q Form (Health and Fitness Questionnaire)

Does your child have any of the following?


PLEASE ASK YOUR CHILD TO COMPLETE THE FOLLOWING QUESTIONS

What do you normally do during break-times at school?

How many hours a day do you watch TV?

How many hours a day do you play computer games?

Do you play outside of school, either with your friends or in teams?

Does it usually make you feel ………

Does being involved in physical activity such as cycling, gymnastics, football, netball etc make you feel (please tick)

PLEASE PRESS THE BUTTON BELOW TO SUBMIT

DISCLAIMER CLAUSES

  •  In consideration of being permitted to utilise the facilities, services and programs of R4C Health Solutions t/a WildForestGym (WFG) (or for my children to so participate) for any purpose,including, but not limited to observation or use of facilities or equipment, or participation in program, the undersigned, for himself or herself and such participating children and any personal representatives, heirs, and next of kin, hereby acknowledges, agrees and represents that he or she has, or immediately upon entering or participating will, inspect and carefully consider such premises and facilities or the affiliated activity.  It is further warranted that such entry into the facility for observation or use of any facilities or equipment or participation in such affiliated program constitutes an acknowledgement that such premises and all facilities and equipment thereon and such affiliated activity have been inspected and carefully considered
    and that the undersigned finds and accepts same as being safe and reasonably suited for the purpose of such observation, use or participation by the undersigned and such children.
  • The undersigned is aware of the different types of activities, equipment, and facilities offered by WFG, and is aware of the risks inherent in the participation in such activities and use of such equipment and facilities.
  • In further consideration of being permitted to enter the facility for any purpose including, but not limited to observation or use of facilities or equipment, or participation in any program activity with WFG, the undersigned hereby agrees to the following:
    1.   The undersigned on his or her behalf and behalf of such children, hereby releases, waives, discharges and covenants not to sue WFG its directors, officers, employees, and agents (hereinafter referred to as “releasees”) from all liability to the undersigned or such children and all his personal representatives, assigns, heirs, and next of kin for any loss or damage, and any claim or demands therefor on account of injury to the person or property or resulting in death of the undersigned or such children whether caused by the negligence of the releasees or otherwise while the
    undersigned or such children is in, upon, or about the premises or any facilities or equipment therein or participating in any activity affiliated with WFG.
    2.   The undersigned hereby agrees to indemnify and save and hold harmless the releasees and each of them from any, loss, liability, damage or cost they may, incur due to the presence of the undersigned or such children in, upon or about the premises or in any way observing or using any facilities or equipment of WFG or participating in any activity
    whether caused by the negligence of the releasees or otherwise.
    3.   The undersigned hereby assumes full responsibility for and risk of bodily injury, death or property damage to the undersigned or such children due to negligence of releasees or otherwise while in, about or upon the premises and/or while using the premises or any facilities or equipment thereon or participating in any activity affiliated with WFG.
  • The undersigned further expressly agrees that the foregoing release waiver and indemnity agreement is intended to be as broad and inclusive as is permitted by the law of the country and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.
  • The undersigned has read and voluntarily signs the release and waiver of liability and indemnity agreement, and further agrees that no oral representations, statements or inducement apart from the foregoing written agreement have been made.
  • I am aged 16 or over and the guardian or parent of the child undertaking the activity and am legally permitted to sign this disclaimer on their behalf.
  • I understand that I or any other person that I authorize to bring and collect the child from the club will also release and waiver of liability should you or that authorized person injury themselves whilst at the gym.
  • I understand that all activities undertaken at R4C Health Solutions Limited t/a Wild Forest Gym (WFG) are physically and mentally challenging and there is risk involved. This includes but is not limited to water based and other obstacles, surface, trip, slip and eye hazards, and a risk of falling from height.
  • Although the WFG training facilities has strict safety standards and is risk assessed the risk of serious injury or death associated with WFG cannot be totally eliminated. Therefore I understand that participation in activities and the use of facilities at WFG is entirely at my and my child’s own risk. Furthermore I understand that I have informed my child to only attempt an obstacle or training if it’s safe to do so and is within his/her capabilities.
  • I understand that the land owner tests some but not all of the water used in the obstacles for microbiology. This is done on a risk of ingestion basis.
  • My child is fit and well and not on any medication of and sort that would impede him/her taking part in the event and if he/her is that you have sought medical advice from his/her doctor before taking part and made WFG aware.
  • If my child has any medical history, medical reason, injury or illness then I will inform WFG in writing no less than 24hrs prior to a club activity.
  • I consent to emergency medical care and transportation in the event of injury to my child in order to obtain treatment medical professional deem appropriate.
  • I have asked my child to comply with all instructions given to him/her by the organisers, employees and volunteers of WFG and he/she will use equipment correctly and as directed (if necessary) so as not to hurt or injure anyone.
  • I understand that WFG reserves the right to cancel or modify any training sessions if WFG feels such conditions would otherwise create an unsafe environment.
  • I agree that as to any equipment, which I/my child provide or borrow from WFG during use of the gym, that WFG shall not be liable for any loss or damage due to my/my child’s misuse or my negligence.
  • I agree that WFG are not responsible for any personal items or property that is lost or stolen at WFG.
  • I give permission to the WFG to use my/my child’s photo and/or any other record of my participation at WFG for any legitimate purpose. I understand that all likenesses of me captured during the training sessions by the organisation or staff shall become the sole property of the organiser.
  • I understand that WFG takes no liability or responsibility for any mistakes, errors or inaccuracies made by participants including negligence or misuse on my part or those that I am guardians for.
  • I agree that I will not sue, or otherwise make any claim against WFG, or its employees, agents (whether paid or volunteer), and contractors due to my child’s negligence of misuse.
  • I agree that WFG, its employees, agents and contractors, will not be legally responsible for any loss, injury or damage of any kind to me, my heir, or assigns, resulting from the negligence or misuse by the me/ my child.
  • Members Guests. If you wish to bring guests i.e. family members, colleagues, family or children along then it is hereby agreed that you will be fully responsible for their care and supervision at all times as there is a risk of injury, accident or possibly death of your guests. If not signed in on club session then they are not to use the gym, apparatus, obstacles or trails. If you personally are not able to supervise them, then you will make sure that another suitable adult will be available to take on this responsibility. At no times are a member of the Wild Forest Gym Crew, PT or Coach able to take on such responsibility.
  • The management will not be responsible for any loss or damage to personal possessions, valuables or vehicles.
  • As a guardian of a child under the age of 16yrs old I hereby agree that I will be fully responsible for their care and supervision at all times when not in a session as there is a risk of injury, accident or possibly death. If I personally are not able to supervise them, then I will make sure that another suitable adult will be available to take on this responsibility. At no times are a member of the Wild Forest Gym Crew, PT or Coach able to take on such responsibility.
  • I have declared any medical conditions, which may risk his/her own safety and that of others, to one of the members of staff.
  • I am legally competent to sign this Release.
  • If I am signing on behalf of a minor, I agree to the terms above and the conditions for supervising children on display outside the office.

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