ABN: 65 861 621 504 Office Use Only Woodchop Entry Form Paid Served by ………….……… To the Secretary, Subject to the Rules, By-Laws, Regulations of the above Society, I wish to make the following entries for the forthcoming Show. Exh No Office Use Only Sect No Class No Carded  Receipt No. ………….……… Data Input by ………….…… Description of Exhibit Entry Fee Total Entry Fees Payable Exhibitor Details Mr/Mrs/Miss/Ms Full Name ……….……………………………………..………..………. 2-day Exhibitors Passes will be issued to competitors only. Postal address …………………………………….…………….….…… …………………………………………………….…………………….…. Family members may purchase either pre-sold gate passes or buy passes on Show days. Town…………………………...... State…….……. Postcode…..….… Phone No…………………….…… Mob …..…………………………… Email ………..…………………….……………………………………… I hereby certify that I have read the Show Rules and the Conditions of Entry and agree to be bound thereby. Signature……………………………..…………………………...…… Date……………………………………...……… Please turn over & sign Dangerous Activity Acknowledgement Telephone (07) 4091 4260 Email: [email protected] Web: www.athertonshow.com.au Dangerous Activity Acknowledgement Participant Details Mr/Mrs/Miss/Ms Full Name ……….…………………………………….………..………………………………….. If under 18 years Guardian's Full Name ...…………………………….....………..……………………………….. Postal address …………………………………….…………….….…………………………………………………..…...… ……………………………………………………………………………………………………………………...…...….……. Town…………………………………………..…….………... State…….……………….. Postcode…….……..…........ Phone No…………………………………………….…....….…… Mob …..………………………………...……………… Email …………………………………………………………….…………………….………………………..……………… In consideration for being permitted to participate in any way in wood-chopping activities, I, the undersigned, understand, acknowledge and accept: • That wood-chopping is a dangerous activity and that the use of axes and chainsaws can result in sudden and unpredictable (changeable) consequences. • • That there is a significant risk that serious injury or death may result from wood-chopping activities. The dangers associated with the consumption of alcohol or any mind altering drugs and agree not to drink alcohol or take drugs prohibited by law before or during any wood-chopping activities. I agree to follow the directions of any event organiser or official and that any misconduct or refusal by me to follow any direction of any organiser or official can result in the cancellation of my participation in the activities and my immediate removal from the Arena or the Showgrounds no matter where that may occur. I agree to take all appropriate safety measures at all times whilst participating in the activities. I agree to indemnify the Atherton Tableland Agricultural Society Inc, against Liability for any accident, damage, loss or illness caused to anyone, including but not limited to myself or my property, or a member of the public during any part of the event, including but not limited to preparation, competition, judging, performing or displaying. I have had sufficient opportunity to read this Dangerous Activity Acknowledgement and fully understand its terms and sign it freely and voluntarily. Signature of participant …………………..……………………………………… Date………………………………...…… For Participants of Minority Age (Under Age 18) This is to certify that I, as a parent/guardian with legal responsibility for this participant, acknowledge, understand and accept all of the above and consent and agree to my minor child's involvement or participation in wood-chopping activities. Signature of guardian ………………..……………………………………… Date……………………………………...…… Telephone (07) 4091 4260 Email: [email protected] Web: www.athertonshow.com.au