I, whose signature appears on this form being a person who has reached the age of 18 years in consideration of and as a condition of participation in combats conducted at the Gathering 2005, for myself, my heirs, wards, executors and administrators, hereby waive all and any claim, right or course of action which I might otherwise for or arising out of loss of live or injury, damage or loss of any description whatsoever that I might suffer or sustain in the course of or consequent upon my entry or continuing participation in the said events.
I hereby acknowledge that I am fully aware of the nature and purpose of the activities to be conducted at the Gathering 2005, that these activities are potentially dangerous, and that I voluntarily accept the risks involved.
Furthermore, I agree to abide by the Gathering 2005 combat rules, including all such amendments as may be made during the Gathering 2005, and the directions and instructions of the Gathering 2005 Officials.
In the event of any disagreements or disputes arising from my participation in combats conducted at the Gathering 2005, I agree to submit such disagreements to a board of arbitration appointed by the Organisers of the Gathering 2005, and to abide by any decision reached by such a board.
This waiver, release and discharge shall be and operate separately in favour of all persons, corporations and bodies involved or otherwise engaged in promoting or staging the events and the servants, agents, representatives and officers of any of them.
And I make this solemn declaration by virtue of the penalties provided by the Statutory Declarations Act 1959 (Cth) for the making of false statements in Statutory Declarations, conscientiously believing that the statements contained in this declaration to be true in every particular.
Name (Please print): __________________________________________________________________________
Signature: _____________________________________________ Date:________________________________
Declared at: ________________________________ on the _____________ day of __________________, 2005
Before me: __________________________________________________________________________________
a. a Magistrate
b. a Justice of the Peace
c. a Commissioner for Affidavits
d. a Commissioner for Declarations
e. a Notary Public
f. a person before whom a statutory declaration may be made under the law of the State in which the declaration is made; or an Australian Consular Officer or an Australian Diplomatic Officer as defined by section 2 of the Consular Fees Act 1955.