Building Connections - Nature and Kayaking Program

Name of Participant

First NameLast Name

Which program are you registering for?

Participant Date of Birth

Name of Parent/ Carer completing registration form.

First NameLast Name

Contact Number for Parent

Please enter a valid phone number.Format: 0000 000000.

Address

Street Address

Street Address Line 2

Post Code

Email

example@example.com

For the Sunday Program, please tick which date you are interested in attending or if you wish to attend all, please tick all?

Group numbers are limited.

Does your Child have Disabilities and/or any medical, health issues that we need to be aware of ie Diabetes, heart issues? Please provide in addition any medical plans, behaviour plans that we need to be aware of, in supporting your child during our program.

Could you please advise if your child can swim and at what level. We have never had a capsize!!

All participants will need to wear a life jacket and we are not anticipating anyone to go in the water.

Only Relevant for School Holiday Program - Does your child have any physical limitations when it comes to a 30 - 45 minute, 2km hike? Difficulty: Very Easy/ Grade 1-2, Terrain: Mostly flat.

Does your child have any allergies?

We will be providing light refreshments after the canoe ride.

Does you child have a NDIS Plan and do you wish to invoice under their Plan? Please provide NDIS Number.

Programs are ususally billed under social and community participation or core supports. Feel free to email to discuss further.

Is your Child Planned Managed or Self Managed if billing under child's plan?

If Planned Managed please provide Planned Managers contact details (name and phone number.)

Email Address for Invoices.

Please note this program is billed either under core supports or capacity building-improve social and community participation. Please ensure your child's Plan has available funds otherwise invoices will need to be paid by you.

Secondary Emergency Name and Contact number

Please select if you consent or do not consent to the use of photographs or video recordings of me/my child taken during the activity for promotions/social media.

Cancellation Policy - Due to the limited spots for these sessions, any cancellation that has occurred less then 24 hours before the event, will be charged at the full cost of the session.

Waiver Policy

1. Acknowledgment of Risk
I, the undersigned, acknowledge that kayaking is an outdoor activity that carries inherent risks, including but not limited to drowning, injury from falling, collisions, weather conditions, and equipment failure. I understand that despite all reasonable precautions, accidents can occur.

2. Assumption of Risk

I voluntarily agree to participate/my child to participate in the kayaking activities organized by Adonai Equine Services as part of the Building Connections program. I accept full responsibility for any injury, loss, or damage that may occur as a result of participation in this activity.

3. Release and Waiver

To the fullest extent permitted by NSW law, I hereby release, waive, and discharge Adonai Equine Services, its owners, employees, contractors, and volunteers from any and all claims, demands, damages, or causes of action arising out of or related to my/my child’s participation in the kayaking and hiking activities, including claims resulting from negligence.

4. Medical Treatment

In case of an emergency, I authorize Adonai Equine Services and its representatives to obtain medical treatment for me/my child if deemed necessary. I agree to be responsible for any medical costs incurred.

5. Compliance with Safety Instructions
I agree to follow all safety instructions, guidelines, and directions given by the instructors or organizers during the activity, including the use of safety equipment such as life jackets.

6. I agree to appropriate clothing being worn by my child, including sunscreen and hat for protection. I understand sunscreen will be available during the day for my child to access.

Please confirm by signing the below, that you have understood and agreed to the waiver policy and the cancellation policy.

Name of person who has signed.