New member application

Fill in the form below and we will get back to you as soon as possible.

(Fields marked * are required.)
* First Name: * Last Name:

* Street Address:

* Town: * Postcode:

* Phone 1: Phone 2:

ONLY the year please * Year Of Birth:

* Email:

This person would be contacted if something happened to you on a club activity

* Emergency Contact Name:
* Emergency Contact phone:

Do you have any medical conditions that a walk leader may need to be aware of?

Medical Condition:

Are you a member of another club ?

Yes: |

Do you have first aid qualifications?

First Aid: | Remote Area First Aid: | First Aid valid till:

The answers to the following questions will help us put on activities that suit our membership.

Tick as many as apply:

Have you ever led walks?

No: | Some: | Regularly (eg scouts, Duke of Ed): | No, but would like to find out more: |

Email preferences:

Members receive the following emails:

a weekly bulletin with upcoming walks
short notice emails when a walk is added with less than 3 days notice (XSNW walk)

Click to opt out of either of these emails:

Weekly bulletins: | Short notice emails: |

Waiver (acknowledgment of risk)

Please read carefully the text in the waiver below, and type 'I agree' in the space below if you wish to continue with your application. You should receive an email confirming your application and agreement.

By signing this you agree to the waiver.   <br>
This Acknowledgement of Risk applies to all club activities I may undertake as a
member of the Springwood Bushwalking Club. In voluntarily participating in Club
activities I am aware that I may be exposed to hazards and risks that could lead to
injury, illness or death, or to loss of or damage to my property. These risks may
include but are not limited to slippery and/or uneven surfaces, rocks being dislodged,
falling at edges of cliffs or drops or elsewhere, risks associated with crossing creeks,
hypothermia and heat exhaustion.    <br>
In particular when participating in abseiling or above the snowline activities I am aware
that I may be exposed to additional hazards and risks. I also acknowledge that I may
be in locations where evacuation for medical treatment may take hours or days.       <br>
I will make all reasonable effort to avoid or minimise these risks by:
1. only participating in activities within my capabilities,
2. carrying food, water and equipment appropriate for the activity,
3. advising the leader if I am taking any medication or have any physical or other
limitation that might affect my participation in the activity,
4. making every effort to remain with the rest of the party during the activity,
5. advising the leader of any concerns I am having, and
6. complying with all reasonable instructions of the activity leader, and
7. not leaving the party before the conclusion of any activity, without the leaders
prior knowledge and consent.
I have read or heard and understand these requirements. I have considered the risks
before choosing to agree to these conditions. I still wish to be a member of the Club. I agree by
signing this form to waive any claim for damages arising from participation in a Club
activity that I may have against the Club, the leader or other participants in tort or
contract. I acknowledge that I will take responsibility for my own actions and will help
others to complete the activity safely.

* Your agreement:

Enter the letters and numbers from the image here:

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