Y-Rock Birthday Party Invite

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					           Y-Rock Birthday Party Invite
                                            To: __________________________________

                   & Other Fun Activities
                   Indoor Rock Climbing
                                                     You’re invited to enjoy all the fun at the
                                                                          Birthday Party of

                                            ____________________________________________________________                                  Y Xtreme Adventures
                                                                                                                                       Y-Rock Indoor Rock Climbing
                                            Date: _____________________________________                                                           51 Mundy Street
                                                                                                                                                  Bendigo, Victoria
                                            Time: _____________________________________                                                      Phone: 0417 371 208
                                                                                                                                                   Fax: 5441 2888
                                            Please RSVP to: ___________________________________                                  
                                                             By the:_________________________________
                                            Please wear comfortable active clothing and bring the attached wavier form with you to Y-Rock.
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
                                                                    Please detach the Waiver form and return on the day.

                                                                          Birthday Party
                                                                                                          Participant Waiver
Please Print All Details Clearly.

Name                                                                                                                   Date of Birth
Address                                                                                                                Post Code
Emergency Contact                                                                                                          Phone
Medical Issues
    Parental / Guardian permission must be secured for participants who are not of legal age (18 yrs).

I will be attending a YMCA Y Xtreme Adventures program. I recognise that the activities I will be involved in are energetic
and may involve an element of risk (i.e. climbing with ropes). In the event of an accident, I request that the instructors
secure emergency services to provide aid, if in their judgement such services are necessary. I agree to incur any
additional expenses associated with such action. I have decided (with or without medical advice) that I am physically,
socially and mentally able to participate, and acknowledge that any medical or accident insurance we consider
necessary will be my responsibility to locate and purchase.

Furthermore, I have read and agree to the terms on this form, and do hereby release the Bendigo Regional YMCA, Y
Xtreme Adventures and its employees from liability for any damages, injuries, or losses which may occur while I am
participating in this program.

Note:              All participants must use specified safety equipment and procedures during all activities.
                   A fee maybe charged for any lost or damaged equipment.
                   Almost all activities are suitable for participants aged 7 years and over however participants under 13
                   years are NOT permitted to belay.
                   Any photographs or video footage taken by YMCA Staff maybe used in promotional material
                              (Tick box to opt out ).
I hereby declare that the information on this form is true and correct, I have read, understood & accepted the
YMCA Rules, Terms and Conditions (on display in the centre and on our website).

Signature                                                                                                                     Date
                 Signed by - Participant / Parent / Guardian

Print Name
(if different to name on top of form)

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Description: Y-Rock Birthday Party Invite