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Insurance Disclaimer

JUA Underwriting Agency Pty Limited



RISK WARNING ACKNOWLEDGMENT AND ASSUMPTION OF RISK RELEASE AND INDEMNITY


WARNING - THIS IS AN IMPORTANT DOCUMENT WHICH AFFECTS YOUR LEGAL RIGHTS AND
OBLIGATIONS. READ IT CAREFULLY AND DO NOT SIGN IT UNLESS YOU ARE SATISFIED THAT YOU UNDERSTAND IT. IF YOU HAVE ANY QUESTIONS PLEASE ASK OUR REPRESENTATIVE.


RECREATIONAL ACTIVITY PROVIDER: OCEAN PILATES
______________________________________________________________________________

PARTICIPANTS NAME:
______________________________________________________________________________

PARTICIPANTS AGE:
______________________________________________________________________________
(If under 18 years parent/guardian to also sign)

PARENT OR ACCOMPANYING PERSONS NAME:
______________________________________________________________________________


WARNING AND ACKNOWLEDGMENT OF RISKS. INJURY AND OBLIGATIONS

I acknowledge that the activity I am to undertake is a recreational activity that may involve a risk of harm (the "activity") and that by participating in it I am exposed to certain risks.

I further acknowledge that I am not required to engage in the activity.

I ACKNOWLEDGE AND UNDERSTAND that whilst participating in the activity:

• The activity may cause injury, physical or mental, or cause death.

• Personal property may be lost or damaged.

• Other persons participating in such activity may cause me injury or may damage my
property.

• Injury may be caused to other persons or their property may be damaged.

• The conditions in which the activity is conducted may vary without warning.

• Injury, physical or mental, or death or damage to property may result from the
negligence of, or breach of an express or implied term of a contract by, the Recreational
Activity Provider.

• There may be no or inadequate facilities for treatment or transport in the event of
injury.

• The person participating in the activity assumes the risk of and responsibility for any
injury, death or property damage resulting from participating in the activity.


RELEASE AND INDEMNITY TO THE RECREATIONAL ACTIVITY PROVIDER

IN CONSIDERATION of my payment for participating in the activity (and except to the extent
that the same may be precluded by statute) I AGREE THAT with the Recreational Activity
Provider as follows:

1. I participate in the activity at my own risk and responsibility.

2. I have received a risk warning in relation to the recreational activity.

3. I hereby release and hold harmless the Recreational Activity Provider, its servants and
agents, from and against all and any actions, demands, suits, proceedings or claims
which may be made by me or on my behalf or by other parties on my behalf for or in
respect of or arising out of any injury, loss, damage or death caused to me or my
property whether by negligence, breach of contract, breach of any express or implied
warranty that the recreational services or activity will be rendered with reasonable care
or skill, breach of any statute or statutory duty or in any way whatsoever.

4. In the event that I am injured or my property is damaged, I will bring no claim, or
commence any legal proceedings, against the Recreational Activity Provider in respect of
that injury or damage.

5. I hereby indemnify and keep indemnified the Recreational Activity Provider from and
against all and any actions, demands, suits, proceedings or claims that may be brought
or made against the Recreational Activity Provider by any person by reason of or in
respect of any act, default or neglect by me in participating in the recreational services
or activity or in anyway whatsoever relating thereto or arising therefrom and from and
against any costs and expenses that may be incurred by that person in connection with
such actions, demands, suits proceedings or claims.

Before signing this document I have read and understood it and know that it affects my legal
rights.


SIGNED BY:
______________________________________________________________________________

DATE:
____________________________________________

WITNESS:
______________________________________________________________________________


WHERE PARTICIPANT IS UNDER 18 YEARS OF AGE

I,____________________________________ HEREBY ACKNOWLEDGE AND AGREE THAT:

• I am a parent of or the person who is accompanying the person who is to participate in
the recreational activity.

• I have read the whole of this document and understand it.

• I consent to the person named in this acknowledgment and release participating in the
activity.

• I have received from the recreational activity provider a risk warning and I am aware of
the risks, dangers and obligations set out above in this acknowledgment and release.

• If I am not the parent of the person named in this Acknowledgement, I shall at all times
during the recreational activity keep such person be under my control or I shall
accompany such person.

IN CONSIDERATION OF the person named in this Release and Indemnity being accepted to
participate in the activity I AGREE TO RELEASE AND INDEMNIFY the Recreational Activity
Provider in the same manner and to the same effect and extent as if I were the person first
named in this Acknowledgment and Release and the person participating in the activity.

SIGNED BY:
______________________________________________________________________________

DATE:
____________________________________________

WITNESS:
______________________________________________________________________________