Indemnity Form

Release and Waiver of Liability and Indemnity – Go Bush 4WD Club is a non profit activity group, formed to facilitate and to encourage those with a common interest.

In consideration of being able to participate in any activity, facilitated or connected to Go Bush 4WD Club, the undersigned for himself or herself, personal representative, heirs, assigns, passengers and relatives, HEARBY RELEASES Go Bush 4WD Club and their respective facilitators, organisers, leaders, hereafter referred to as RELEASEES of any and all liability to the undersigned, whether caused by an act of neglect or omission of releasee’s or otherwise, while the undersigned is for any purpose participating in a group activity. It is fully understood by the undersigned that there is some risk associated with the group activity, including damage to vehicles.

In addition, the undersigned AGREES TO INDEMNIFY AND HOLD HARMLESS the releasee’s from any loss, liability, damage or cost they may incur due to such participation by the undersigned and AGREES TO ASSUME FULL RESPOSIBILITY AND RISK for bodily injury, death or property damage from releasee’s negligence or otherwise while the undersigned is participating in the group activities. In signing the release, the undersigned hereby acknowledges and represents the following:

  • That he/she has read and understands the foregoing Release and Waiver of Liability and Indemnity Agreement.
  • That his/her said vehicle is insured and licensed and is in compliance with all applicable state laws and will be operated in such a manner.
  • That the owner/driver agrees to assume full responsibility for his/her passengers including family members, guests, friends and acquaintances and all other persons that accompany the undersigned.

Vehicle Colour: _____________ Make: _____________ Model: _____________ Rego: _____________ Insured Y/N: ____

Driver’s Signature : ________________________________ Print Name : _______________________________

Email : _______________________________________________ Mobile : _________________________________

Date Signed : ________________________ Club Member’s Signature : _______________________________