RENAULT SNOWCLUB 3-5yrs

RENAULT SNOWCLUB 3-5yrs
Information About the Child
RENAULT SNOWCLUB 3-5yrs
Child’s Medical & Health Information
............................................................................
Child’s Full Name
Registration Form
. . . . . . . . . / . . . . . . . / . . . . . . . Date of Birth
. . . . . . . . . . . . . . Age
Male Female
............................................................................
Language Spoken at Home
Information About the Child’s Parents or Guardians
Asthma NO/YES (specify) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Diabetes NO/YES (specify) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dizzy Spells NO/YES (specify) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Black Outs NO/YES (specify) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Migraine NO/YES (specify) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Other NO/YES (specify) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
City
....................................
. . . . . . . . . State
. . . . . . . . . . . . . Postcode
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Home Phone Number
Mobile Phone Number
Holiday Address: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Accommodation Name
Number & Street
City
. . . . . . . . . State
. . . . . . . . . . . . . Postcode
............................................................................
Accommodation Phone Number
Medical/Hospital Insurance Fund:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Does your child have allergies to any medication?
NoYes
............................................................................
The only person/s authorised to collect child from Renault Snowclub:
Is your child presently taking tablets/medication?
Person One:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ............................................................................
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Has your child been diagnosed at risk with anaphylaxis? No
Yes
Does your child have an auto injection device (EpiPen®)? No
Yes
Do we need to administer medication whilst in our care?
Yes
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Contact Phone Number
Person Two:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Full Name
Relationship to Child
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Contact Phone Number
Yes
No
............................................................................
If yes, please specify
............................................................................
Court Orders Are there any court orders relating to the child?
No
Name of Medication & Dosage
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
NoYes
............................................................................
Does the child have any special dietary requirements?
No
Yes
............................................................................
If yes, please specify
If yes, please specify
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Medicare Number: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . If yes, please specify
Relationship to Child
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your accommodation and the Snowsports Office.
NoYes
Collecting the Child from Renault Snowclub
Full Name
d
Immunisation: Has your child been immunised?
Year of Last Tetanus Immunisation:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ............................................................................
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
are available online at skifalls.com.au, fallscreek.com.au, from Ticket Outlets,
Behaviour Problems NO/YES (specify) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Heart Condition NO/YES (specify) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Number & Street
participating in the Renault Snowclub 3-5 year-old ski Program. Registration Formson Recycled
Disability NO/YES (specify) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Home Address:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . For your child’s safety, we require a completed Registration Form for each child
Diet Restrictions NO/YES (specify) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Full Name of Parent/Guardian with whom the child resides
Please bring this completed Registration Form with you
when registering your child in Renault Snowclub.
Allergy NO/YES (specify) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ............................................................................
Call 03 5758 1070
Visit www.skifalls.com.au
Is the child toilet trained? NoYes
We do not accept children who are wearing nappies or not toilet trained.
Proud Partner
Kids Snowsports School
Does your child suffer from any of the following? (Please Circle)
Falls Creek is committed to the environment.
This registration form is printed on 100% Recycled Paper. All inks & varnishes used in
the printing process are vegetable based ensuring this publication is 100% Recyclable.
Privacy Statement
Visit our website at www.skifalls.com.au to view
Falls Creek Ski Lifts Pty Ltd privacy statement
ustain
All medication must be handed to Falls Creek Snowsports School prior
to the parent/guardian leaving the child. It is the parent’s/guardian’s
responsibility to clearly label medicine containers with the child’s name,
the dose to be taken and when it should be taken.
These medications will be kept by Falls Creek Snowsports School and
distributed as directed. If it is necessary or appropriate for the child
to carry their own medication (eg asthma puffers, insulin etc) it must
be with the knowledge and approval of both the parent/guardian
and Falls Creek Snowsports School.
1.
EXCLUSION OF LIABILITY The Supplier, its employees, directors and agents are not liable
to you or your child (listed on this form) or to your dependants or legal representatives
for personal injury or death suffered by your child due to the recreational activities
not being supplied with due care and skill or not being reasonably fit for any purpose
which you made known to the Supplier, or because the recreational activities failed
to achieve any result reasonably expected by you which you made known to the
Supplier, or for breach of any other of the consumer guarantees applied by the
Australian Consumer Law (Victoria), or due to the negligence, breach of contract or
statute or statutory duty by the Supplier in any way relating to or arising from the
sale or supply of recreational activities by the Supplier to you.
Please provide details of any medication to be carried by the child.
2.
RISK WARNING AND WAIVER TO SUE You acknowledge that the recreational activities
are dangerous with many inherent risks and hazards and as a consequence personal
injury (including serious personal injury) and sometimes death can occur and you
assume and accept all such risks on behalf of yourself and your child and hereby
waive the right which you or your child may have to sue the Supplier for any
personal injury or death suffered by your or your child in any way whatsoever
caused by or arising from your child’s participation in such activities.
Child’s Doctor:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Full Name
............................................................................
Number & Street
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
City
. . . . . . . . . . . . . . . . . . . . . . State
Postcode
............................................................................
Phone Number
All information on this form is intended to assist Falls Creek Snowsports School in case of any medical
emergency with the child. All medical information will, as far as is practicable, be held in confidence
and will be stored where there will be restricted access, however you may access this information on
request. Your contact details and this form will be retained in case they are needed for future use.
Nearest Medical Facility:
Falls Creek Medical Centre, Bogong High Plains Road,
Falls Creek, VIC 3699. Telephone: (03) 5758 3238.
n
I authorize Falls Creek Ski Lifts Pty Ltd to take all steps considered
reasonably necessary to protect the child’s welfare during the child’s
participating in Falls Creek Snowsports School activities including taking
steps to obtain emergency medical and/or dental treatment if
required. I acknowledge such treatment may include helicopter or
ambulance transport or hospitalisation as well as anaesthesia and/
or surgery if recommended by a duly qualified medical practitioner.
I agree to be responsible for all expenses incurred by Falls Creek
Ski Lifts Pty Ltd in respect of any such emergency services.
Yes
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Signature
Release & Waiver
Falls Creek Ski Lifts Pty Ltd, being the Supplier of recreational services in
the Falls Creek Alpine Resort supplies and sells all Snow Pass Media and all
recreational services including skiing, snowboarding, tobogganing, snowtubing,
skiing and snowboarding lessons, other activities organized by the Falls Creek
Snowsports School, snow making, snow grooming, the use of chair lifts,
t-bars, poma lifts, moving carpets, rope tows, the condition, layout, design,
construction, maintenance, grooming and use of ski/snowboard slopes and
surrounds, including the presence of people or objects thereon or nearby,
and all other associated sporting activities or similar leisure time pursuits
(recreational activities) subject to the following conditions:
5. On behalf of your child you the undersigned accepts and assumes all risks, dangers
and hazards associated with recreational snowsports and the use of any facilities
provided by or operated by Supplier at the Resort.
3. You acknowledge that:
3.1 The Supplier strongly recommends that all skiers and snowboarders wear
accredited helmets whenever skiing or snowboarding and also recommend
that snowboarders wear wristguards.
3.2 The wearing of an accredited helmet is compulsory for:
(a) all persons participating in skiing or snowboarding lessons in terrain,
rail or half pipes, freestyle or freeform lessons or programs, ski or
snowboard racing, race training and skiercross or boardercross; and
(b) all children aged 3 to 14 years whilst participating in ski and snowboard
school lessons or in any other snow sports program.
3.3 You hereby waive the right to sue the Supplier for any head or brain injuries
and loss or damage you or your child may suffer due to your child’s failure to
wear an accredited helmet as recommended and required by sub paragraphs
3.1 and 3.2 and you also agree to indemnify and hold harmless the Supplier
against any claims by your child for any personal injury suffered
by your child due to his/her failure to wear an accredited helmet.
6. You acknowledge and agree that:
(a) Your child will not consume alcohol or illicit drugs whilst participating in
the recreational activities. If such use occurs the Supplier may exclude your
child from any of its facilities at the Resort without refund or compensation;
(b) Your child has been asked to observe all signs and to comply with all
directions of Supplier, not to access parts of the Resort marked as closed,
to act safely at all times and you agree to be fully responsible for any claim by
third parties’ for personal injury, resulting from any act or omission by your
child or which is attributable in any way to your child’s conduct and will fully
indemnify and hold harmless Supplier against any claims that may be brought
against it arising in any way from the conduct of your child which causes
personal injury or death to another person;
(c) The Supplier has an unrestricted right to deny your child access to any of its
facilities which includes ski lifts and terrain of the Resort if your child acts in
any way which, in the sole opinion of Supplier, is deemed to be reckless or
which in the sole opinion of Supplier damages the terrain;
(d) The Supplier reserves the right to close any of its lifts or facilities at the Resort
and in such situation there will be no refund or compensation;
(e) Your child is in good health and that there are no special problems associated
with the care of your child that the undersigned has not disclosed and there
are no special instructions regarding the child that have not been listed on
this form;
(f) The Supplier is collecting, using and dealing with your personal information
in accordance with its privacy policy, which is accessible from
www.skifalls.com.au; and
(g) These conditions shall be governed by and construed firstly in accordance
with the laws of the State of Victoria and then in accordance with the laws
of the Commonwealth of Australia. If any of these conditions should be
determined to be void, invalid or otherwise unenforceable, it shall be
deemed deleted and the remaining conditions shall remain and continue
to be valid, binding and enforceable.
4.
WARNING UNDER THE AUSTRALIAN CONSUMER LAW AND FAIR TRADING ACT 2012:
Under the Australian Consumer Law (Victoria), several statutory guarantees apply
to the supply of certain goods and services. These guarantees mean that the
supplier named on this form is required to ensure that the recreational services
it supplies to you:
7.
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are rendered with due care and skill; and
are reasonably fit for any purpose which you, either expressly or by
implication, make known to the supplier; and
might reasonably be expected to achieve any result you have made
known to the supplier.
Under section 22 of the Australian Consumer Law & Fair Trading Act 2012, the
supplier is entitled to ask you to agree that these statutory guarantees do not
apply to you. If you sign this form, you will be agreeing that your rights to sue the
supplier under the Australian Consumer Law & Fair Trading Act 2012 if you are
killed or injured because the services provided were not in accordance with these
guarantees, are excluded, restricted or modified in the way set out in paragraphs
1, 2 and 3.3 above.
Note: The change to your rights, as set out in this form, does not apply if your
death or injury is due to gross negligence on the Supplier’s part. Gross negligence,
in relation to an act or omission, means doing the act or omitting to do an act with
reckless disregard, with or without consciousness, for the consequences of the act
or omission. See regulation 5 of the Australian Consumer Law & Fair Trading Act
2012 and section 23(3)(b) of the Australian Consumer Law & Fair Trading Act 2012.
Note: Where the words “you” or “your” are stated in the above warning, those
words apply to “you” or “your child”.
By signing this agreement the undersigned is not relying on any oral or written
representations or statements made by Supplier with respect to the safety of
the facilities of Supplier or of the terrain at the Resort other than what is set out
in this form.
The undersigned has read and understood this release and
waiver and agrees to be bound by it on the undersigned’s own
behalf and as parent or guardian of the child.
.............................................
. . . . . . . . . /. . . . . . . . /. . . . . . . . SignatureDate
n
I agree that as the child’s standard of skiing improves that
the child can use ski lifts.
Yes No
Please tick the box if you wish for your child to NOT receive
a cup of warm chocolate.
Was this manual useful for you? yes no
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