Participants Full Name
*
First Name
Last Name
Preferred Name
Email
*
Phone
(###)
###
####
Date of Birth
*
MM
DD
YYYY
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Gender identity
Female
Male
Non-binary
Genderfluid
Agender
Prefer not to say
Other (please specify)
If you selected ‘Other’ please specify:
Pronouns
Occupation
Guardian/ Caregiver
First Name
Last Name
Relation to the Participant
Phone
(###)
###
####
Email
Representative Completing This Application (If Not the Participant or Guardian)
Name:
Email:
Phone:
Relation to the Participant:
Emergency Contact
*
First Name
Last Name
Relationship to Participant
*
Phone
*
(###)
###
####
What Brings You Here?
*
Tell Us About You
*
Favourite Activity
*
Mountain Biking
Canoeing/Kayaking
Hiking
Four Wheel Driving
Fishing
Overnight Adventure Camps
Other - I would like to chat more about activities
Your Journey: Which places or trails have you explored? How long have you been involved in this adventure?
Ideal Appointment Days
*
Monday
Tuesday
Wednesday
Thursday
Friday
Preferred Time Slots
Early Morning - approx 6am-9am
Mid Morning - approx 9am-12pm
Lunch - approx 12pm-3pm
Early Afternoon - approx 3pm-6pm
Diagnosis
Intolerances
Height
*
NDIS number
Fund Management
Self-managed
Plan-managed
NDIA-managed
Plan Start Date
MM
DD
YYYY
Plan End Date
MM
DD
YYYY
NDIS Plan Goals
Assumption of Risk, Liability Waiver, and Indemnity Agreement
*
This Assumption of Risk, Liability Waiver, and Indemnity Agreement (“Agreement”) is made between SNDY Tracks (“Provider”) and the undersigned participant (“Participant”). By signing this Agreement, the Participant (or legal guardian, if applicable) acknowledges and accepts the risks associated with participation in SNDY Tracks adventure-based counselling and activities.
1. Acknowledgment of Risk
I understand and acknowledge that participation in SNDY Tracks activities involves risks, including but not limited to:
• Physical exertion, injury, or illness.
• Exposure to environmental conditions, such as weather changes and uneven terrain.
• Interaction with wildlife, natural elements, and outdoor hazards.
• The possibility of accidents due to unforeseen circumstances, personal limitations, or interactions with others.
I acknowledge that SNDY Tracks takes reasonable precautions to ensure safety but that some risks are inherent to outdoor activities and cannot be eliminated.
2. Medical and Fitness Declaration
I confirm that I am medically and physically fit to participate. I understand that I am responsible for disclosing any pre-existing medical conditions, allergies, injuries, or disabilities that may affect my ability to participate safely.
I acknowledge that SNDY Tracks relies on the information provided by me and that failure to disclose relevant medical conditions may increase my risk of injury.
3. Voluntary Assumption of Risk
I acknowledge that I voluntarily participate in SNDY Tracks activities and assume all inherent risks associated with them. I understand that SNDY Tracks takes reasonable steps to ensure safety but cannot guarantee a risk-free experience.
4. Limitation of Liability
To the fullest extent permitted by law, I:
• Release and discharge SNDY Tracks, its staff, contractors, and affiliates from liability for personal injury, death, or property damage arising from the inherent risks of participation.
• Acknowledge that this waiver does not apply to gross negligence, reckless conduct, or failure to meet legal safety obligations by SNDY Tracks.
I understand that this clause does not waive my rights under Australian Consumer Law where protections apply.
5. Indemnification
I agree to indemnify and hold harmless SNDY Tracks from any third-party claims arising from my own actions, misconduct, or failure to follow safety guidelines. This does not apply to claims arising from SNDY Tracks’ negligence.
6. Compliance with Safety Rules
I agree to follow all safety instructions and policies provided by SNDY Tracks. If I fail to comply, I understand that I may be removed from participation without a refund.
I acknowledge that:
• I have been advised to use appropriate safety gear during activities.
• The use of alcohol, drugs, or impairing substances before or during activities is strictly prohibited.
7. Reporting of Injuries or Incidents
I agree to immediately report any injury, accident, or property damage to SNDY Tracks staff before leaving the activity location.
8. Medical Treatment & Expenses
If I suffer an injury or illness, I consent to SNDY Tracks providing first aid assistance and arranging emergency medical treatment if necessary.
I acknowledge that:
• I am responsible for my own medical expenses, including ambulance or evacuation costs.
• If an injury occurs due to SNDY Tracks’ negligence, legal liability protections apply as per consumer law.
9. Media Release & Privacy
I consent to SNDY Tracks taking photos/videos during activities and using them for promotional and marketing purposes.
Opt-Out Option: If I do not wish to have my image used, I will notify SNDY Tracks in writing before my participation begins.
10. Communication Consent
I consent to SNDY Tracks contacting me regarding participation, updates, and relevant program opportunities.
11. Cancellation & Refund Policy
I acknowledge that:
• If SNDY Tracks cancels a session due to weather or unforeseen circumstances, I may reschedule or receive a refund.
• If I cancel with at least 48 hours’ notice, I may reschedule.
• No-shows or last-minute cancellations may result in forfeited fees, except under extenuating circumstances.
12. Governing Law & Agreement Terms
This Agreement is governed by the laws of NSW, Australia.
If any provision is found to be unenforceable, the remaining sections apply in full effect.
EXCLUSION FROM THE PROGRAM
SNDY Tracks reserves the right to exclude any participant from the program or activities for reasons including, but not limited to:
1. Failure to comply with SNDY Tracks’ instructions, safety guidelines, or policies.
2. Failure to adhere to the SNDY Tracks Code of Conduct.
3. Failure to agree to the SNDY Tracks Terms and Conditions.
4. If SNDY Tracks staff determine that a participant is not in a fit state (physically, mentally, or emotionally) to safely participate.
5. Outstanding payments owed to SNDY Tracks, unless an alternative arrangement has been made.
6. Any other reasonable determination made by SNDY Tracks, at its sole discretion, to protect the safety and integrity of the program.
TERMS AND CONDITIONS
I accept the SNDY Tracks Terms and Conditions, available at https://www.sndytracks.com.au/terms-and-conditions.
PRIVACY POLICY
I accept the SNDY Tracks Privacy Policy, available at https://www.sndytracks.com.au/privacy-policy.
AGREEMENT
I acknowledge that I have read and understood this Assumption of Risk and Liability Waiver. It has been explained to me where necessary, and I fully understand its terms.
I am aware that by ticking the box below, I am waiving certain legal rights and I assume responsibility for the risks involved.
I complete this document by ticking the box below freely and voluntarily, without coercion or inducement, and I intend my acknowledgment of this to serve as a complete and unconditional release of liability, to the fullest extent permitted by law.
The participant or their representative has read (or had the terms clearly explained to them) and fully understands this Assumption of Risk and Liability Waiver.
Completed Date
*
MM
DD
YYYY
Full Name of Participant or Representative who completed this form
*
How did you hear about us?
Google
School Wellbeing Team
NDIS Coordinator
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Friend/Family
Other