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P age |1
Northern Rivers Bushwalkers Club Inc.
ACTIVITY ATTENDANCE/RISK ACKNOWLEDGEMENT FORM
Date: ___ /___ /___
Grade: ______ Name of Walk: ________________________________________________
Leader: _________________________ Meeting place & time: ____________________________________
Location/s of start and end of walk ___________________________________________________________
Estimated time of return: ________
Emergency Time (if applicable): __________________________
Emergency Contact Person: Name and Phone No. ______________________________________________________
(if applicable)
NRBC Personal Locator Beacon registered contacts:
David: (02) 66298339 Mob. 0427 298339 [email protected]
Bert: (02) 66868834 [email protected]
Mike: (02) 66215250 [email protected]
Ian: (02) 66847733 [email protected]
-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
ALL PARTICIPANTS – PLEASE READ CAREFULLY BEFORE YOU SIGN BELOW
I have read the Northern Rivers Bushwalkers Club’s Essential Information Document relevant to the activity and my
signature below affirms that:
1. I accept and will comply with the club’s policies, procedures and requirements as outlined therein.
2. I acknowledge the risks associated with this activity.
Children (under 16 years) must be accompanied by an authorised responsible adult who is required to accept full responsibility for the child. The
authorised responsible adult must sign alongside the child’s name, where it appears below, and that signature shall be confirmation of the acceptance
of that responsibility.
Name (printed)
Revised Feb 2013
Signature
Phone No.
Meeting Details
P age |2
Northern Rivers Bushwalkers Club Inc.
ACTIVITY ATTENDANCE/RISK ACKNOWLEDGEMENT FORM
Date: ___ /___ /___
Grade: ______ Name of Walk: ________________________________________________
-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
ALL PARTICIPANTS – PLEASE READ CAREFULLY BEFORE YOU SIGN BELOW
I have read the Northern Rivers Bushwalkers Club’s Essential Information Document relevant to the activity and my
signature below affirms that:
1. I accept and will comply with the club’s policies, procedures and requirements as outlined therein.
2. I acknowledge the risks associated with this activity.
Children (under 16 years) must be accompanied by an authorised responsible adult who is required to accept full responsibility for the child. The
authorised responsible adult must sign alongside the child’s name, where it appears below, and that signature shall be confirmation of the acceptance
of that responsibility.
Name (printed)
Revised Feb 2013
Signature
Phone No.
Meeting Details
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