Dirt Groms | Term 4 2023.
Event Address: Gold Coast Cycle Centre, 2 Hope Street, Nerang.
Contact us at 0438443899 or ride@gcmtb.com.au
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Participant Name *
Participant D.O.B. *
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Participant AUSCyling/MTBA#
GCMTB Online Order Number (provided when you purchase the Dirt Groms package) *
If you are not an AUSCycling/MTBA member, you understand you are able to purchase a day recreational permit. By not purchasing this permit, you are not covered by the MTBA Insurance policy for public liability or personal accident cover. You engage in this activity at your own risk and responsible for any expenses should be held liable for a negligent act or should you suffer personal injury. *
Required
Parent/Caregiver Name *
Email Address (for class communications) *
Mobile Number (for class communications) *
RIDER QUESTIONS
How would you rate your child's riding ability?
Beginner
They'll be pro next year!
Clear selection
Does your child suffer from any illnesses or allergies that will affect their participation in Dirt Groms? Please give details… *
Do you consent to your child’s image being used on social media? *
DECLARATION
TERMS and CONDITIONS including ASSUMPTION OF RISK AND WAIVER OF LIABILITY
Organiser, Gold Coast Mountain Bike Club Inc (“GCMTB”), its subsidiaries, its members (including,
but not limited to, its affiliated State Constituent Associations as defined in the ACF constitution) and
clubs affiliated with Constituent Associations, and their respective directors, officers, members,
servants or agents. “Claim” means and includes any action, suit, proceeding, claim, demand,
damage, penalty, cost or expense however arising including but not limited to negligence BUT does
NOT include a claim against the Organiser by any person entitled to make a claim under a relevant
CA insurance policy. "Cycling Activities" means performing or participating in any capacity including
but not only as a Member in any authorised or recognised Organiser activities.
NOTE: Section 74 of the Trade Practices Act (“Act”) implies a warranty of due care and skill into
contracts for the supply of services to consumers, as defined in the Act. To the extent that the
warranty applies to any contract relevant to the Release and Waiver of Liability, it cannot be
excluded.
1. I declare that I am medically and physically fit and able to participate in Cycling Activities. I
acknowledge that I must, and I agree that I will, disclose any pre-existing medical or other condition
that may affect the risk that either I or any other person will suffer injury, loss or damage.
2. I acknowledge that the Organiser relies on information provided by me, and that all such
information is accurate and complete.
3. I acknowledge that Cycling Activities are inherently dangerous. I recognise that there are risks
specifically associated with Cycling Activities which include, but are not limited to, collisions and
contact with other participants, the remoteness of the areas in which an event takes place, sudden
and unexpected changes in weather, physical exertion and difficulties in evacuation if I become
disabled. I acknowledge that accidents can and often do happen which may result in me being
injured or even killed, or my property being damaged.
4. I understand and acknowledge the dangers associated with the consumption of alcohol or any
mind-altering substance before or during any Cycling Activity, and I accept full responsibility for
injury, loss or damage associated with the consumption of alcohol or any other mind-altering
substance.
5. I agree to follow any rules set by the Organiser in connection with any Cycling Activities. In
particular, I have been advised to wear an approved helmet at all times during Cycling Activities. If I
fail to comply with the ORGANISER’S rules and/or directions, I will not be permitted to participate or
to continue to participate and no refund will be given.
6. I have voluntarily read and understood these warnings and accept and assume all risks associated
with my participation in Cycling Activities, including the possibility or injury, death, loss or damage.
7. In consideration of the organiser accepting my entry I:
a) release and will release the Organiser from all Claims that I may have or may have had but for
this release arising from or in connection with my participation in Cycling Activities; and
b) indemnify and will keep indemnified the Organiser to the extent permitted by law in respect of
any Claim by any person arising as a result of or in connection with my membership or my
participation in Cycling Activities.
8. I further agree to indemnify and keep indemnified the Organiser against all Claims made by any
other person against the Organiser in respect of any injury, loss or damage arising out of or in
connection with my failure to comply with the Organiser's rules and/or directions.
9. I agree and acknowledge that, to the extent permitted by law, the Organiser shall not be liable for
any injury, loss or damage I suffer or by any other person arising from or in connection with my
participation in the ride, whether such injury, loss or damage was caused directly or indirectly by the
negligence of the Organiser or otherwise, or by the Organiser’s servants or agents.
10. To the extent permitted by law, I acknowledge and agree that all warranties, covenants and
stipulations implied by law are hereby excluded.
Initial:________
11. I agree to report any accidents, injuries, loss or damage I suffer during any Cycling Activities to
the Organiser before I leave the relevant venue.
12. If I suffer any injury or illness, I agree that the Organiser may provide evacuation, first aid and/or
medical treatment at my expense and that my acceptance of these terms and conditions constitutes
my consent to such evacuation, first aid and/or medical treatment
13. Copyright and right to use image: I acknowledge and consent to photographs being taken of me
by or on behalf of Organiser during my participation in the Event. I acknowledge that the
photographs are owned by the Organiser and that the Organiser may use the photographs for
promotional or other purposes without my further consent being obtained. Further, I consent to the
Event organisers using my name, image, likeness and also my performance in the Event, at any time,
to promote the Event by any form of media.
All of the above are bound by the policy and must comply with it.
EXCLUSION FROM THE EVENT
The Organiser reserves the right to exclude any entrant or participant from Cycling Activities, for
reasons including but not limited to:-
(i) failing to comply with the Organiser's directions;
(ii) failing to comply with GCMTB Code of Conduct;
(iii) failing to comply with GCMTB Anti-Doping Policy;
(iv) not being in the opinion of the Organiser in a fit state to participate;
(v) being un-financial or owing monies to GCMTB unless an alternative arrangement has been
made.
(vi) for any reason determined by the Organiser, which determination shall be deemed
reasonable.
I ACKNOWLEDGE THAT I HAVE READ THIS ASSUMPTION OF RISK AND THAT IT HAS BEEN EXPLAINED
TO ME, AS REQUIRED. I FULLY UNDERSTAND ITS TERMS AND THAT I HAVE GIVEN UP SUBSTANTIAL
RIGHTS BY SIGNING IT. I SIGNED THE DOCUMENT FREELY AND VOLUNTARILY WITHOUT ANY
INDUCEMENT MADE TO ME AND INTEND MY SIGNATURE OR OTHER ACKNOWLEDGEMENT TO BE A
COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY
LAW.
Signed (Name) *
Date *
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