City Summit Membership application form and liability waiver

Perths rock climbing centre

ABN: 56 170 522 907
PH: 9248 7035 Unit 2/26, Harris Rd Malaga, WA www.citysummit.com.au

Name: ______________________________________________________________ Address: ____________________________________________________________ Suburb: __________________________ Postcode: _______ Date of Birth: __/__/__ Phone: _______________________ Mobile: ________________________________ Email: ______________________________________________________________ How did you hear about us? _____________________________________________ Have you climbed before? Yes No If yes, what grade climber are you? _____ Lead? Yes No Trad? Yes No
Contract Conditions for use of City Summit Facilities

In these conditions: "Activities" means any use of the Facilities in any way whatsoever. "Facilities" means all the equipment, climbing walls, ropes, harnesses and all and every other piece of equipment in City Summit premises. "I" means personally or by his/her parent or guardian. "City Summit" means City Summit ABN 56 170 522 907, and includes its staff whether officers, employees, instructors or guides. 1. I understand that the Trade Practices Act 1974 implies into this contract with City Summit that I will have the benefit of certain warranties which cannot be excluded, restricted or modified and in particular warranties that: 1.1 The service to be supplied by City Summit will be rendered with due care and skill and that any material supplied in connection with those services will be reasonably fit for which the purpose they are supplied, and 1.2 Where I make known to City Summit, expressly or by implication the particular purpose for which I require the services or the result I desire the services to achieve, the services and any material in connection with those services will reasonably be expected to achieve that result, except where the circumstances show that I do not rely or it is unreasonable for me to rely on those skills or judgement of City Summit. 2. Except to the extent that I have the benefit of those warranties, I hereby waive any or all other rights and any claims resulting there from that I may now and in the future have against and release from all liability whatsoever City Summit for any personal injury, death, property damage or loss sustained by me as result of my participation in Activities provided by City Summit, or taking place on the property belonging to City Summit, due to any cause whatsoever, including without any limitations, negligence at common l aw on the part of City Summit. 3. I am aware that the Facilities, in addition to the usual inherent risks, have certain additional dangers of which may include: 3.1 Physical exertion for which I am not prepared 3.2 The use of climbing equipment which if used incorrectly fails to perform its designed purpose. 4. I accept all the inherent risks of the proposed Activities and acknowledge that the enjoyment and excitement is in part derived from the inherent risks incurred by participation in an activity where risks are greater than the accepted safety of life at home or at work 5. In entering into this contract, I am not relying on any oral, written or visual representations or statements by City Summit or any other inducement or coercion to participate in the Activities, and do so of my own free will. 6. Our Privacy Policy: 6.1 We are committed to protecting your privacy. We use the information you provide to advise about and assist with your adventure and climbing interests. We do not trade, rent or sell your information 7. I confirm that I have read: 7.1 The above and understood this contract prior to signing it and agree this will be binding upon my heirs, next of kin, executors and administrators 7.2 The Rules and Regulations displayed on the notice board relating to the Facilities at City Summit and agree to be bound by them 7.3 Your Privacy Policy 8. I agree that this agreement shall be governed in all respects by and interpreted in accordance with the law in force in the state of Western Australia SIGNATURE: _____________________________________________________________________ Date: ____ / ____ / ____

Parent or Guardian to sign if under the age of 18 years I __________________________________ being the parent/guardian of _________________________ hereby consent to my child participating in the above activities and agree to abide by the terms of conditions as set out above. Signature of Parent/Guardian: __________________________________________________________ Date ___/___/___

Membership Number: _______________________________