Personal Details

Medical Details

Entrants and participants in the Extreme Tour For Hunger Ride presented by Meals On Wheels Community Services (‘the event’) acknowledge that although all precaution have been taken by the organizing body to ensure the safety of all participants, there may be dangers inherent in participation in the Event and the activities related hereto.

Participants voluntarily assume the risk of attendance at and participation in the Event and hereby waive all claims of whatsoever nature and howsoever arising in relation to the Event or otherwise against any parties, including but not limited to the organizing body, the sponsors, the advertisers, any local authority and/or directors, employees, suppliers and assistants of these parties, including any individual Meals On Wheels Community Services Employees.

Participants hereby irrevocably indemnify and hold harmless the parties against any liability and claims of any nature whatsoever and arising (whether directly or indirectly caused and whether inconvenience, accident, death, injury, illness to their person, theft or loss or damage to property or costs and expenses sustained, incurred or put to by Participants.

I grant permission to Meals on Wheels Community Services to use images taken of me.

Such use includes the display, distributions, publications, transmissions or otherwise use of photographs, images and/or videos taken for use in materials that include, but may not be limited to, printed materials such as Brochures, Newsletters, Videos and digital images used on Meals on Wheels Community Services Website and Social Media Pages, such as Facebook and for Meals on Wheels Community Services’ Fund-raising Events.

Medical Questionnaire

1. Fitness Levels and Regular Exercise

Do you currently have, or ever suffered from any of the following? (Tick only those that apply) 

In this document MOWCS refers to Meals on Wheels Community Services.

This is an agreement to comprehensively release MOWCS from arising claims out of participation in the Extreme Ride for Hunger Tour. Please communicate with MOWCS regards to any potential risks involved in the activity you signed up for. This form makes your assumption of risk complete.

In the event that I am rendered unconscious due to injury or illness, or if I am deemed unable to make sufficient judgement calls, I hereby authorise MOWCS Staff to act in my best interest and for my own personal safety. In consideration of the services I am to receive from MOWCS, I assume risks involved and release MOWCS from any claims, damages or liabilities that may arise out of these services as per our booking agreement.

I accept that in some instances MOWCS only act as coordinator of such activities such as transportation, accommodation and otherwise and hereby accept the terms and conditions set by these external service providers. I hereby accept these services will not hold MOWCS liable for any claims, damages, or liability that may arise out of these services.

If the schedule has to be delayed or altered in any way due to weather, trail, road or other conditions beyond the control of MOWCS, it is accepted that the responsible guide or agent for MOWCS will have the authority to make a judgement call in this regards. Any unexpected changes and issues arising from such delays or alterations is an assumed risk and MOWCS will not be held liable for any claims, damages or liability that may arise from such decision.

The MOWCS Event Coordinator on the tour retains the right to exclude any client from an activity (part or in full) if he/she deems it in the best interest of the client or the rest of the group.

I have read and understood all the information contained in this document, and hereby confirm that all information I supplied are accurate and complete.

If any changes occur between submission of this form and your trip please share the details with us.

Cyclist Rules Agreement

1. Be On time – make sure to network on the WhatsApp group, your alarm etc.
2. Adhere to all traffic rules and regulations at all time.
3. At all times wear your helmet.
4. Ride in the same direction as flow of traffic.
5. Cycle as one group. No Cyclist will be allowed to ride off the front. It is not a race.
6. Weaker cyclist work less at the front, stronger cyclist on the other hand will work for longer periods at the front.
8. Do not overlap wheels.
9. Indicate if there is any objects in the road, potholes, bottles, bricks, stones etc.
10. If you have a problem fall to the back of the pack, raise your hand and the backup vehicle will assist you.
11. Come prepared with extra tubes and patching kit.
12. Eating and drinking etc, normally happens at the back of the pack.
13. Inappropriate behavior and foul language will not be tolerated, please communicate respectfully.
14. Assigned water points will be along the way +/- every 2 hours to refresh and refuel.
15. 15 minute breaks will be allocated at water points, starting when the last cyclist gets there.
16. Very important if you need any extra Medications/strapping/tubes/tyres, or anything that falls out of the tour, it will be available but on your own account - we will place it on a tab for you till the end of the tour.
17. Misuse of substances – alcohol, drugs or any illegal substance, will not be accepted.

I agree to comply with ALL the rules of the Extreme Ride for Hunger Tour as outlined above. I do understand that if I do not adhere to the above mentioned rules then Meals on Wheels Community Services reserve the right to terminate my participation in the Extreme Ride for Hunger Tour and to send me home without re-reimbursement.

Where did you hear about the Extreme Ride4Hunger? (Please tick applicable options) 

NB. Please Ensure you have read ALL Terms and Conditions, by ticking the accept boxes you hereby accept and agree to ALL terms and conditions