Name *

First Name

Last Name

Date *

MM

DD

YYYY

Time *

Hour

Minute

Second

AM PM

I declare I am physically fit and capable of safely operating a mountain bike. *

Yes

I acknowledge that I have been provided with an approved helmet and advised to wear this helmet whilst riding the mountain bike. I also acknowledge that it is illegal to ride a mountain bike on a public road in New Zealand whilst not wearing an approved helmet. *

Yes

I declare that I have inspected the mountain bike and equipment and I am satisfied that they are in good working condition and suitable for use. *

I agree

I take full responsibility for the safe use and operation of the mountain bike during my stay. *

I agree

By taking unsupervised use of the mountain bike, I indemnify Hapuku Lodge and its owner, General Manager and staff against any and all events arising through use of the mountain bike, which may result in physical or mental injury to me or other people and damage to any property including the mountain bike and any associated equipment. *

I agree

I accept that mountain biking involves a degree of risk of injury, damage to equipment, or in extreme cases, death. *

I agree