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HUNTER AREA WALKABOUT CLUB INC.

 

 

APPLICATION FOR MEMBERSHIP OF HUNTER AREA WALKABOUT CLUB INC.

January 2014

(incorporated under the Associations Incorporation  Act, 2009)

 

I, ________________________________________________________________________________  

                                                        (Full name of applicant)

Of ______________________________________________________________________________  

                                                                (Address)

Post Code ______________                       Phone Number __________________________________

Mobile_________________________________   e-mail ___________________________________

Occupation_____________________________________      Current First Aid Certificate    YES/NO

hereby consent/do not consent to my name, address, phone and mobile numbers being distributed throughout the Club on a public list

hereby apply to become a member of the Hunter Area Walkabout Club Inc. In the event of my admission as a member, I agree to be bound by the constitution of the Club for the time being in force.

Hunter Area Walkabout Club Inc. has Public Liability and Personal Accident Insurance. Please note and acknowledge the following Club Disclaimer regarding Insurance Excesses:

Claimants for Insurance Benefits from the Clubs’ Insurance Policies  - Personal  Accident Policy Number 0012117 and Public Liability Policy Number 408306 (sourced from Bushwalking NSW Inc.)

should note that the excesses for these Policies is the responsibility of the Claimant for each and every Claim. Hunter Area Walkabout Club Inc. is not responsible for excess payments under any circumstances.

                        SAMPLE ONLY

Signature of Applicant _______________________________________________

Date _____________________________________

AS PART OF THIS APPLICATION FORM THE RISK WAIVER FORM OVERLEAF MUST BE SIGNED BY THE APPLICANT.

I,  _______________________________________________________________________________

                                                          (Full name)

a member of the Hunter Area Walkabout Club Inc., nominate the applicant for membership of the Club.
Signature of the Proposer___________________________________________________

Date: __________________________________________

I,  _______________________________________________________________________________      

                                                          (Full name)

a member of the Hunter Area Walkabout Club Inc., second the nomination of the applicant for membership of the Club.

Signature of the Seconder ___________________________________________________

Date: __________________________________________

 

HUNTER AREA WALKABOUT CLUB  INC.

P.O. BOX 166 NEW LAMBTON, NSW 2305

 

                                                                                                                                                                                                             RISK WAIVER FORM

                                                             In voluntarily participating in any activity of the Hunter Area Walkabout Club Inc. I am aware that this may expose me to risk that could lead to injury, illness or death or loss of or damage to my property.

          Those risks may include, but are not limited to, slippery and/or uneven surfaces, rocks being dislodged, falling at edges of cliffs or drops or elsewhere, risks associated with crossing creeks, hypothermia and heat exhaustion.

                                                           To minimise these risks I will endeavour to ensure:

                                                                      That any activity in which I participate is within my capabilities and that I am carrying enough food, water and equipment appropriate for the activity. I agree to advise the activity leader if I am taking any medication or have any physical

                                                                      or other limitations that might affect my participation in the activity.

                                                         I will make every effort to remain with the rest of the party during the activity and accept the instructions of the leader of the activity.

                                                         I have read or heard and understood these requirements and I have considered the risks before choosing to sign this form.

                                                        I still wish to participate in the activities of the Hunter Area Walkabout Club Inc.

                                                        I agree by signing this form to waive any claim for damages arising from this activity that I may have against the club, the leader or other participants in tort or contract.

 

SIGNED  _____________________________________________________

PRINT NAME _________________________________         DATE   ____________________

 

 

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