Positive Start Winter Camp Registration

Personal Details

Name of Camper*

Date of Birth*

Age your child will be at camp*

In order to allocate your child accommodation, to which gender identity do they most identify?*

What school does your child attend?*

Please provide your Positive Start Code (given to you after registration with Positive Start)*

What year level is your child in at school?*

Horse Riding Ability*

Novice (never ridden)
Beginner (ridden before, minimal horse control, walk only)
Inexperienced (minimal horse control, seated trot)
Moderate Experience (moderate horse control and can rise to the trot comfortably)
Experienced (excellent horse control and capable of a quick canter)

Emergency Contacts

Emergency Contact #1

Emergency Contact #1 Email*

Emergency Contact #1 Phone*

Emergency Contact #2

Emergency Contact #2 Email*

Emergency Contact #2 Phone*

Medical Details

Family Doctor

Clinic Name & Address*

Does your child have any medical conditions/concerns? Please provide details below:

Does your child take any medication? What is the name of the medication?

Instructions for the medication:

Dietary Requirements

Please provide details below:

ALL ANAPHYLACTIC CAMPERS MUST PROVIDE A COPY OF THEIR ASCIA FORM 2 WEEKS PRIOR TO ARRIVING AT CAMP.

Consent

Media Consent*

I give consent to The Ranch to take photographs and/or video footage of the camper listed above during program participation to use in promotional material including marketing material (brochures / fliers), print and online media (newspapers/magazines, blogs, our website) and/or social media. I also acknowledge that no fee or other charge is payable to The Ranch for that use of this material and that The Ranch owns all copyright of the photographs and/or videos.

Yes
No

Do you consent for a group photo to be taken and sent to all campers at the end of camp.*

If you select no, your child will be excluded from the group photo.

Yes
No

Please list any preferences you may have e.g. Siblings bunking together, friends together etc. We will do our best to accommodate your requests.

General Waiver Agreement and Release*

The Customer acknowledges and agrees that it has read the Terms and agrees to enter into a legally binding agreement upon signing this General Agreement and Release.

WAIVER, RELEASE AND INDEMNITY
1.1 Bass Strait Views Pty Ltd ACN 068 766 156 trading as The Ranch (The Ranch) operates the adventure park located on 810 Boneo Road, Cape Schanck, Victoria (Site) where guests may participate in, with the approval of The Ranch, the following:
(a) Horse Riding;
(b) Mountainboarding;
(c) Giant Swing;
(d) Rock Climbing;
(e) Pamper Pole;
(f) Archery
(g) Crate Stack; and
all other activities including, but not exclusive to the team building activities, initiatives course, sports courts, swimming pool and trampoline (collectively, the Activities)

1.2 The person specified below as the “Guest” is a guest of The Ranch. The person or entity specified below as the “Customer” has contracted with The Ranch as part of a booking. If a Customer is named below, then the corresponding Guest is attending the Site at the direction of the Customer.

1.3 The Ranch has agreed to allow the Guest onto the Site, and to participate in the Activities and any other activity, on the condition that the Guest provides this waiver and release in favour of The Ranch (including any of its directors, officers’ employees and or agents).

2. General Waiver

2.1 In consideration of The Ranch allowing the Guests onto the Site, the Guests unconditionally and irrevocably:
(a) agree to sign this form without any inducement or coercion whatsoever;
(b) agree to follow all reasonable directions from The Ranch and its staff, including as to the Activities, any other activity and the use of and access to the Site;
(c) voluntarily assume all risk in entering onto the Site and participating in the Activities and any other activity; and
(d) indemnify and will keep The Ranch (including its directors, officers, employees and or agents) harmless from and against any claim, loss or liability arising from any negligence or wilful act or omission of The Ranch.

3. Recreational Services

3.1 Where a Guest attends the Site, and participates in all or any of the Activities, then in consideration of being permitted to participate in the Activities, the Guest acknowledges and agrees as follows:
(a) that the Activities constitute recreational services;
(b) to the maximum extent permissible by law, The Ranch is not liable for the Guest’s death, physical or mental injury and disease which arises from, or is connection with guarantees which may be excluded under the Australian Consumer Law and Fair Trading Act 2012 including:
(i) to provide the services with due care and skill;
(ii) that the services will be reasonably fit for the purpose for which the services are provided; and
(iii) that the services will be of such a nature, quality, state or condition that they might reasonably be expected to achieve their purpose.

WARNING UNDER THE AUSTRALIAN CONSUMER LAW AND FAIR TRADING ACT 2012
Under the Australian Consumer Law (Victoria), several statutory guarantees apply to the supply of certain goods and service. These guarantees mean that the supplier named on this form is required to ensure that the recreational services it supplies to you:
● are rendered with due care and skill; and
● are reasonably fit for any purpose which you, either expressly or by implication, make
known to the supplier; and
● might reasonably be expected to achieve any result you have made known to the supplier.

Under section 22 of the Australian Consumer Law and Fair Trading Act 2012, the supplier is entitled to ask you to agree that these statutory guarantees do not apply to you. If you sign this form, you will be agreeing that your rights to sue the supplier under the Australian Consumer Law and Fair Trading Act 2012 if you are killed or injured because the services provided were not in accordance with these guarantees, are excluded, restricted or modified in the way set out in this form.
NOTE: The change to your rights, as set out in this form, does not apply if your death or injury is due to gross negligence on the supplier’s part. “Gross” negligence, in relation to an act or omission, means doing the act or omitting to do an act with reckless disregard, with or without consciousness, for the consequences of the act or omission. See regulation 5 of the Australian Consumer Law and Fair Trading Regulations 2012 and section 22(3)(b) of the Australian Consumer Law and Fair Trading Act 2012.

Parent/Guardian Name*

Parent/Guardian Signature*

Winter Camp Registration
Positive Start Program

Date of Camp: June 29 – July 1, 2022

Personal Details

Emergency Contacts

Medical Details

Dietary Requirements

ALL ANAPHYLACTIC CAMPERS MUST PROVIDE A COPY OF THEIR ASCIA FORM 2 WEEKS PRIOR TO ARRIVING AT CAMP.

Consent

Winter Camp Registration Positive Start Program

Date of Camp: June 29 – July 1, 2022

Personal Details

Emergency Contacts

Medical Details

Dietary Requirements

ALL ANAPHYLACTIC CAMPERS MUST PROVIDE A COPY OF THEIR ASCIA FORM 2 WEEKS PRIOR TO ARRIVING AT CAMP.

Consent

Winter Camp Registration
Positive Start Program