ACT JAM 2025 BMX Event Participation Waiver And Release Form

Over 18

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* 1. Participant:

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* 2. D.O.B:

DD/MM/YYYY

Date

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* 3. Phone number:

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* 4. Emergency contact name:

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* 5. Email address:

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* 6. Emergency contact phone:

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* 7. Emergency contact email:

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* 8. Acknowledgements:

I (“Participant”), acknowledge that I have voluntarily applied to participate in the
ACT JAM 2025 BMX Event taking place on November 7th, 8th and 9th 2025 at Elouera Street, Braddon, ACT 2612 and Stromlo Forest Park, Dave McInnes Rd, Australian Capital Territory 2611.

I certify that I have not been advised to not participate in this or any other similar activity by a qualified medical
professional.

I further acknowledge and agree to, on my own behalf, and on behalf of my personal
representatives, heirs, assigns, executors, administrators and next of kin, as follows.

I AM AWARE THAT THESE ACTIVITIES ARE HAZARDOUS ACTIVITIES AND THAT I COULD BE SERIOUSLY
INJURED OR EVEN KILLED. I AM VOLUNTARILY PARTICIPATING IN THESE ACTIVITIES WITH KNOWLEDGE
OF THE DANGER INVOLVED, AND AGREE TO ASSUME ANY AND ALL RISKS OF BODILY INJURY, DEATH OR
PROPERTY DAMAGE, WHETHER THOSE RISKS ARE KNOWN OR UNKNOWN.

Risks include, but are not limited to: those caused by terrain, facilities, temperature, weather, equipment, vehicular traffic, lack of hydration and actions of other people, including but not limited to participants, volunteers, monitors
and/or producers of the activity.
Upon entering the premises and facilities of ACT JAM 2025 and Stromlo Forest Park, I will inspect the same
and my observation and use of said premises and facilities shall constitute an acknowledgement that I find and accept them to be safe and reasonably suited for their intended purpose. I hereby release FACT BMX Club Incorporated and its officers, members, advisors, volunteers, employees and Governing Board from
and against any and all liability for any loss, damage, injury, expense, demand or cause of action that I
may suffer whether with respect to personal injury, death, damage to or destruction of personal property, theft or otherwise, which may arise as a result of my presence in, upon or about the premises and as a consequence of my participation in this event or use of the facilities and equipment.
I acknowledge that FACT BMX Club Incorporated is NOT responsible for the errors, omissions,
acts or failures to act of any party or entity conducting a specific activity on their behalf.

I understand that while participating in the activity, I may be photographed. I agree to allow my photo,
video or film likeness to be used for any legitimate purpose by the activity holders, producers, sponsors
and assigns.

I CERTIFY THAT I HAVE READ THIS DOCUMENT AND I FULLY UNDERSTAND ITS CONTENT. I AM AWARE
THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND I SIGN IT OF MY OWN FREE WILL.

I CERTIFY THAT I HAVE READ THIS DOCUMENT AND I FULLY UNDERSTAND ITS CONTENT. I AM AWARE
THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND I SIGN IT OF MY OWN FREE WILL.

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* 9. I consent to participate in ACT JAM 2025 given the acknowledgements above:

I consent

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* 10. Participant Signature (Enter Full Name):

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* 11. I acknowledge that by entering my name above I am providing a digital signature.

Yes

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* 12. Date Signed:

Date