I, ___________________________________________ [insert your name],

______________________________ [insert your date of birth] of

___________________________________________ [insert your address],

HEREBY waive and release, indemnify, hold harmless and forever discharge ANNIE ROSE LTD and its agents, instructors, promoters, participants, employees, officers, directors, affiliates, subcontractors, successors, members, trustees, managers and assigns (hereinafter referred to as the Released Party), of and from any and all claims, demands, debts, contracts, expenses, causes of action, law suits, damages and liabilities of every kind and nature, whether known or unknown, in law or equity, that I ever had or may have arising from or in any way related to my participation in any of the functions or activities conducted by ANNIE ROSE LTD on the premises of ANNIE ROSE LTD, or on the behalf of ANNIE ROSE LTD, PROVIDED THAT this waiver of liability does not apply to acts of gross negligence or intentional misconduct.

 I understand that some of the activities that I will participate in are inherently dangerous and can cause serious or grievous injuries, including asthma, allergic reactions, breathing difficulties, bodily injury, industrial sickness, death and damage to personal and/or public property. On behalf of myself, my heirs, assigns and next of kin, I waive all claims for any and all personal injuries and death sustained and/or damage to property, that I may have against the aforementioned released parties caused by such activity whether caused by the ordinary negligence of the released parties or otherwise, with the exception of acts of gross negligence or intentional misconduct, as indicated above.

I have the necessary and requisite skills to participate in all aspects of the functions and/or activities provided by ANNIE ROSE LTD and have no medical condition which precludes me from participating in all aspects of such activities.

I agree to use due care and diligence, at all times, with respect to the use, operation and maintenance of any equipment used, whether by me or others, in connection with my participation in the functions and/or activities of ANNIE ROSE LTD and to safeguard the health and safety of others and protect their property.

By this waiver, I assume any risk and take full liability and responsibility for all claims of personal injury, industrial sickness, death and damage to property caused by my participation in the functions and/or activities of ANNIE ROSE LTD.

By this waiver and release, I agree and submit, solely for matters concerning this waiver and release, to the jurisdiction of the courts of New Zealand and agree, solely for such purpose, that the venue for any legal proceedings shall be Whangarei, New Zealand. The place of this waiver and release and any transactions, contracts and agreements entered into with ANNIE ROSE LTD shall be deemed to be Whangarei, New Zealand, where all matters, whether sounding in contract, equity or tort, relating to the validity, construction, interpretation, and enforcement shall be determined.

This waiver and release forms the basis of the complete agreement between the parties as to liability and supersedes any prior written or oral agreement. The provisions of this waiver and release may only be waived, altered, amended, changed, or repealed, in whole or in part, only upon the written agreement of the parties. All promises, requirements, terms, conditions, provisions, representations, guarantees, and warranties contained herein shall survive the waiver and release expiration or termination date unless specifically provided otherwise herein, or unless superseded by applicable statutes of limitation.

I have read, understand and fully agree to the terms of this waiver and release. I understand and confirm that by signing this waiver and release I have given up considerable future legal actions. I have signed this agreement freely, voluntarily, under no duress or threat of duress, without inducement or undue pressure or improper pressure. My signature is proof of my intention to execute a complete and unconditional waiver and release of all liability to the full extent of the law.

 

DATED this               day of                         20.........

 

Signature [insert name below]

 ____________________________

 

 

Signed in the presence of:

 ____________________________

 

 

First Witness’ Signature

Full name:_________________________________________________

Address:__________________________________________________

Occupation:________________________________________________

 

 

____________________________

Second Witness’ Signature

Full name:_________________________________________________

Address:__________________________________________________

Occupation:________________________________________________

 

Please Note: Adult and each witness must initial each page of this Waiver and Release at the bottom of the preceding pages.