Rider Disclaimer Information and Medical Form for riding Quad bikes Date of Activity?* Time of Activity? *10:00am11:00am12:00pm2:00pm3:00pm Name of which the booking is booked under? * Full Name of Participant? * Date of Birth (*required for anyone under 16 years)01020304050607080910111213141516171819202122232425262728293031day / JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecembermonth / 2018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119201919191819171916191519141913191219111910190919081907190619051904190319021901year Address* Post Code* EmailI declare that:I am in good health and physically fit and have good eye sight.That I am not suffering from any disability or medical condition, including pregnancy, which may make it unsafe for me to ride.I am 16yrs or over filing out this form. That I am not under the influence of alcohol, drugs or any other substance, legal or otherwise.I accept that I will be responsible for any decision as to my fitness to participate in this activity.I agree that Keypitts Off Road Adventures Ltd. reserve the right to terminate my participation of the ride at any time if they consider my actions to be dangerous, negligent and detrimental to my health and safety or other participants.I agree that Keypitts Off Road Adventures Ltd. cannot be held responsible for any accidents caused by my acting in a negligent manner, and that in the event of an accident so caused or contributed to my acting negligently, I waive my right to take legal action against Keypitts Off Road Adventures Ltd. and may be liable to legal action by Keypitts Off Road Adventures Ltd.Quad Bikes must be driven in a proper manner in accordance with the instructions given by the Escorts. Infringements of any of the following may result in the termination of your ride:Deviating from the course set by the Quad escortsOvertaking while in convoyPushing or bumping into other Quad bikesIgnoring instructions given by the Quad escortsAny other action considered to be careless or dangerous by the Quads escortsADDITIONALLYThere shall be no riding of the Quad bikes before the induction brief is doneIn the event of a wilful accident, the offending driver must pay for any damages caused to their vehicle and any other(s)CRASH HELMETS MUST BE WORN and properly fastened during the ride.It is advised you wear long sleeves and trousers. Management reserves the right to cancel the Tour without refund where necessary.RELEASE: I hereby release Keypitts Off Road Adventures Ltd. the owners of the property on which the activity is taken place and any other person participating in this activity with me who might injure me, howsoever arising, from any claims or liabilities without limitation. I make this release on behalf of heirs, my executors, administrators and myself. I understand that failure to abide by the rules and regulations could cause death or injury. EMERGENCY CONTACT - Contact name and relationship* Telephone*I hereby declare that I have read and agree to abide by the above-mentioned conditions, rules and regulations. (Parent or Guardian to sign for anyone under 16 years of age) RIDERS UNDER THE AGE OF 16yrs: Parent/Guardian accepts full responsibility for the child named above and confirms I have read the above to him/her and accepts the child rides at his/her own risk. Signature: Please type you name in full to declare that you have read and agree to abide by the above-mentioned conditions, rules and regulations. * Date* If signing on behalf of rider please state relationship to the rider: Where did you hear about us? Leaflets WebsiteWord of mouth Facebook otherSubmitReset