KOE Waiver & Medical Form Logo
  • KOE Risk Warning, Waiver and Medical Form

    Katherine Outback Experience & Outback Productions
  • Form to be completed by Parent / Legal Guardian if the Participant is under the age of 18 years. 

  • Risk Warning and Acknowledgement

    Your participation in the recreational activities supplied by Katherine Outback Experience and/ or Outback Productions (SUPPLIER) may involve risk. Risks may include (but are not limited too) injury or death caused by falling off a horse, or being kicked, struck, bitten, bumped or stepped on by a horse, dog, goat, cattle or other animal/s. 

    The risks involved may result in personal injury including death. Prior to undertaking any such recreational activity, you should ensure you are aware of all of the risks involved, including those risks associated with any health condition you may have.

    By signing below, you acknowledge, agree, and understand that participation in the recreational services provided by the SUPPLIER may involve risk. You agree and undertake any such risk voluntarily and at your own risk.

    Exclusion, restriction or modification of rights under the Australian Consumer Law (NT)

    Under the Australian Consumer Law (NT), statutory guarantees apply to the supply of certain goods and services, including recreational activities.

    It is possible for a supplier to ask you to agree that these statutory guarantees do not apply to you. If you sign this form, you will be agreeing that your rights to sue the supplier because services provided were not in accordance with the guarantees are excluded, restricted or modified as set out below.

    By signing below, you agree that the liability of SUPPLIER for any death or personal injury (as defined in section 48 of the Consumer Affairs and Fair Trading Act (NT) that may be suffered by me (or a person from whom or on whose behalf I am acquiring the services) resulting from the supply of recreational services is excluded.

  • Terms & Conditions

  • Medical Form 

  • Parent / Emergency Contact

    In the case of any emergency the following information is intended to assist.

  • Personal Information


  • Medication

  • Consent to Medical Attention

    By signing below, I authorise the instructor in charge to administer first aid and call an ambulance. I agree to bear any cost thereby incurred.

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  • Privacy Statement – Privacy Act 1998

  • By completing this form you are supplying the Provider with personal information about yourself. This information is needed to ensure your safety during your time with us. The Provider is required to collect this information by our insurance company and by the department of Workplace Health and Safety. This information you provide will not be supplied to any other organisation or used for any other purpose than that which is stated above

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