Team Member Consent and Risk Disclosure Form

NZ International Soapbox Derby Trust

2014 Soapbox Derby Season

TEAM MEMBER CONSENT AND RISK DISCLOSURE FORM

Team Member’s Name………………………………………………………………………………......

School ......

Address ………………………………………………………………………………......

Contact Phone…………………………………….…..

I (parent/guardian) confirm that I wish my child to participate/compete in the Trolley racing at a Rotary Soap Box Derby event in the 2014 Soapbox Season. These races are organised by The NZ International Soapbox Derby Trust in conjunction with its associated Rotary Clubs – Auckland East Rotary, Waitakere Rotary and Whangaparaoa Rotary.

Acknowledgment of Risk

I have read the information for this activity and I understand that there are risks associated with involvement in the Soap Box Trolley Derby and that these risks cannot be completely eliminated. I understand that the organisers will identify any foreseeable risks or hazards and implement correct management procedures to eliminate, isolate or minimise those hazards. I understand that my child has been involved in the development of safety procedures. I will do my best to ensure that my child follows these procedures.

I know that I am able to ask any questions of the organisers about the activities my child will be involved in to gain a better understanding of the risks involved. I recognise that participation in such activities is voluntary and not mandatory. My child understands that they may withdraw from the activity if they feel at risk. This must be done in consultation with the person in charge.

I understand that the organisers do not accept responsibility for loss or damage to personal property and that it is my responsibility to check my own insurance policy.

I understand that if my child is involved in a serious disciplinary problem or actions that threaten the safety of themselves/others, s/he will be withdrawn from the event immediately.

I also confirm that I understand the nature of the risks of participating/competing in the Soap Box Derby Event specified above and I hereby waive and release any and all claims, rights, causes of action, demands or otherwise, whether for personal injuries, property damage or any loss, damages or expenses which I as a parent/guardian or my child may have against the aforementioned Trust and Clubsor its members in relation to these events.

Name...... (parent/guardian)

Signed………………………………………………......

Date ………………………………………………......

N.B. Drivers to provide a copy of birth certificate or passport.

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