Mount Alexander Shire Council Autumn Billy Cart Bash
Parent/Guardian/Participant Consent Form
I hereby agree and consent
to ……………………………………………………… (Name of participant under 18) / that I am participating in the Mount Alexander Autumn Billy Cart Bash at Castlemaine. I hereby also agree to release, discharge and to hold the Mount Alexander Shire Council harmless for any accidents, harm and/or loss which my above child may suffer, or that I may suffer, as a result of the said child/myself participating in any way in the Mount Alexander Shire Autumn Billy Cart Bash.
In addition, I hereby agree to indemnify the Mount Alexander Shire Council, and its servants and agents, for any loss, demands, damages, expenses, claims, actions, and suits brought for and on behalf of the above child/myself and/or against the above child/myself and arising out of, or in any way connected to, the Mount Alexander Shire Autumn Billy Cart Bash and to take every care in the use of the facility including use of all recognised safety equipment.
I hereby declare that the billy cart that me child/myself is using is sturdy and meets the safety requirements and entry conditions of the event.
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Signature of Parent /
Guardian / Participant
This form MUST be completed by every participant
or a parent / guardian
if the participant is under 18 years of age.
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This form MUST be attached to the official entry form.