Risk Warning and Waiver of Liability for Polo Lessons, Riding, Training & Agistment

Warning: You cannot participate in Polo unless you sign this online waiver.

Provider details

Niall F Coburn, Noosa Country Polo Inc No. 1A4490621 and Noosa Country Polo Events Pty Ltd ACN 650480676 (Noosa Country Polo)
83 Tunba Court, Cooroy Mountain QLD 4563

Our Emergency Contacts

Eileen (illy) Coburn: 0400 196 550
Niall Coburn: 0488 488 649

Our Preferred Veterinarian

Ben Poole
COOROORA Qld 4563
Phone: 0418 762 007

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Participant details

The following pages affect your legal rights and obligations. Please read these carefully and only sign if you fully understand their contents. For Participants under 18 years of age, these documents must be completed by a parent or legal guardian. Description of Activities: Polo, polo lessons, riding, riding lessons, Agistment and handling of Agistee’s horses at Noosa Country Polo, spectators, use of facilities at Noosa Country Polo (“collectively the Activities”). Noosa Country Polo is the provider of the Activities and is defined as, Niall F. Coburn, Noosa Country Polo Inc No. 1A4490621, Noosa Country Polo Events Pty Ltd, and the licences provided by Niall Coburn to Noosa County Polo Inc and Noosa Country Polo Events Pty Ltd to operate the Polo School and events on the property (collectively “Noosa Country Polo”).
DOB*
Date of birth
Address*
Emergency Contact(s)*
Emergency Contact(s)
Full Name
Relationship
Best Phone
 
Waiver*

Declaration & Signature

I have read carefully and understand this risk warning and waiver of liability and sign it freely and voluntarily without inducement of any kind.
Name of person signing this form (where participant is under the age of 18)