* Required

Adult 1*	First Name: Last Name:
Adult 2	First Name: Last Name:
Street Address*
Town*
Postcode*
Mobile Phone - Adult 1*
Mobile Phone - Adult 2
Home Phone
Email Address*
Children's Names And Ages

Please indicate relevant age ranges of adults (for insurance purposes)
19-24	25-34	35-44	45-54	55-64	65+

Family		$100 (includes children under 18)
Single		$50

Family Member 1	Name
	Qualification
	Expiry Date
Family Member 2	Name
	Qualification
	Expiry Date

BEFORE PAYING YOUR MEMBERSHIP FEE please read the safety requirements of Ballarat Bushwalking and Outdoor Club as detailed in the "Acknowledgement of Risks and Responsibilities of Members":

Acknowledgement of Risks and Responsibilities of Members

I / we acknowledge that in participating in activities organised by the Ballarat Bushwalking and Outdoor Club, I am aware that my participation in these activities may expose me to hazards and risks that could lead to injury, illness or death or to loss of or damage to my property. Those risks include, but are not limited to, slippery and/or uneven rocks, rocks being dislodged, cliffs, exposure to weather and whiteout conditions, falling and hypothermia.

To minimise these risks during activities, I will ensure that:

1. Activities are within my capabilities
2. I carry food, water, equipment and personal first aid, appropriate for the activity
3. I will advise the activity leader if I am taking medication or have any physical or other limitation that might affect my participation in the activity
4. I will make every effort to remain with the rest of the party during the activity
5. I will accept the instructions of the leader of the activity
6. Carry the Emergency Information Form detailing any critical medical information and person/s who can act on my behalf
7. I have read or undertake to read the Bushwalking Victoria Code of Conduct, BBOC Bushwalking Guide and BBOC Child safe Code of Conduct (all available to read on BBOC website - www.bboc.com.au).

This acknowledgement of risks applies to all club activities I may undertake. I have read and understand these requirements and risks. I still wish to join in and participate in Club activities.

BBOC Statement of Commitment to Child Safety

The Ballarat Bushwalking and Outdoor Club is committed to providing and actively promoting a safe environment for all children and young people. The club has zero tolerance towards child abuse, and is committed to protecting the physical, emotional, cultural and social wellbeing of all children. Our club is committed to upholding children's best interests and believe that all children have a right to feel and be safe, respected, valued and protected from harm. Our commitment is enacted through A Child Safe Code of Conduct and Risk Assessment and any concerns or allegations will be taken seriously and responded to immediately.

I acknowledge that the payment of my subscription will be deemed as full acceptance and understanding of the above by our family members.