Indemnity Form for Gelball

Please sign the below form prior to undertaking any of our Xperiences. Be sure

to read through the conditions on the bottom of this document.

Acknowledgement, Release and Indemnity

Before participating in any Xperiences HQ Pty Ltd. Xperiences you must read

the information on this form and sign the declaration & disclaimer below. If you

are under 18 years of age, your guardian must also sign this document.

I agree to release, indemnify and hold harmless Xperiences HQ Pty Ltd.

(including the directors, employees, agents, subcontractors, associates and

assignees) (“the Operator”) from and against all claims, demands, actions,

causes of action and all judgments, costs of litigation and fees which may in any

way result or arise out of any injury, loss, damage or death to me or my property

from any use or intended or attempted use by any of the facilities, equipment

and services of the Operator. I agree that in the event that I am injured or my

property is damaged I will bring no claim, legal or otherwise against the

Operator in respect to that injury or damage.

By signing this document, I honestly declare that:

• I am aware that undertaking activities may cause distress or injury. My

personal property may be lost or damaged and I may cause injury to other

persons or damage their property.

• I state that I am not under the inﬂuence of alcohol and / or any drugs that

may affect or impair my ability to safely partake in any Xperiences HQ

Pty Ltd. Xperience in which I am participating.

• I have considered my health and ability to participate in the proposed

activities. I am conﬁdent that my health and safety and that of other

participants will not be put at risk by me taking part.

• I acknowledge that in undertaking any of the activities or using any of the

services, equipment and facilities of Xperiences HQ Pty Ltd. both my

property and my person are solely at my own risk.

• I acknowledge that Xperiences HQ Pty Ltd. does not warrant either

expressly or impliedly, my safety or the safety of others in the use of the

services, equipment and facilities of Xperiences HQ Pty Ltd. .

• I agree to pay for any loss, damage or injuries caused by or resulting from

any inappropriate or improper use of or intended or attempted use by me

of any of the services, equipment and facilities of the Operator.

• I agree to abide by all rules, safety guidelines and regulations established

byXperiences HQ Pty Ltd. and any directions of any employee of

Xperiences HQ Pty Ltd. regarding the use of facilities, equipment and

services of Xperiences HQ Pty Ltd.

• I agree to use the personal protective equipment provided for each

activity as applicable.

• I acknowledge and give permission to Xperiences HQ Pty Ltd. to use my

image in all advertising and marketing publications, both print and

electronic, and store in the electronic photo library available to all

employees of Xperiences HQ Pty Ltd. . I am also giving permission for

Xperiences HQ Pty Ltd. to give this image to a reputable third party

when requested for both print and electronic publications. I agree my

image will be freely available for Xperiences HQ Pty Ltd. to use now

and in the future without further notice or compensation.

Participant Name*

First NameLast Name

Date*

Date

Phone Number*

Please enter a valid phone number.

17 or Younger?

I am 17 years or younger and have my guardian to sign

Guardian Name

First NameLast Name

You may use your finger or mouse to sign below. Please check the box if you are 17 years or younger and your guardian will sign on your behalf.

Signature*