Don's Cottage and Barn.
Accommodation Booking Details.
18 Espie Street    St. Albans.  NSW 2775

GUEST NAME
........................................................................................................................................

ADDRESS    
 ....................................................................................................................................
.....................................................................................................................................

CHILDREN'S NAMES [if any]
.......................................................................................................................................

ADDITIONAL GUESTS
........................................................................................................................................
 
CONTACT NAME [In case of an emergency]   .........................................................

EMERGENCY CONTACT PHONE NUMBER   ..........................................................

CAR REGISTRATION NUMBER  .............................................................................

DRIVERS LICENSE NUMBER  ................................................................................

CREDIT CARD TYPE and NUMBER   ......................................................................

  Safety Disclaimer and Release of Risk
The Guest, [you] are now aware that, during this visit and stay, in which you have chosen to participate under the arrangements of Don’s Cottage St. Albans NSW 2775, Roz Marsh and Ian Richardson, owners of Don’s Cottage St. Albans NSW 2775, their agents, employees and associates; certain hazards may occur, including but not limited to the following hazards; an open water pond, an  unfenced rural property, participating in horse riding, riding in a horse drawn and/or motor driven conveyance, bush walking, flying-fox, swimming, fossicking, camping, fishing and use of the provided facilities, including tank water, subject to the forces of nature. In consideration of, and as payment for the accommodation and/or the right to participate in activities and/or receive the services arranged for me/us by the owners of Don’s Cottage St. Albans and their agents, employees or associates. I/we hereby assume all the risks and will hold them free from any and all liability, actions, courses of actions, debts, claims and demands of any kind or nature whatsoever or for any reason or resulting directly or indirectly from acts of God or myself, which may arise as a result of or in conjunction with my/our accommodation or participation in any activity arranged for me/us by the owners of Dons Cottage St.Albans  and their agents, employees or associates. The terms hereof shall serve as a release and assumption of risk by me, my heirs, executors  administrators and assigns and for all members of my family including any minors accompanying me.
SIGNATURE.............................................................DATE........../........../.............
                 (PARENTAL OR LEGAL GUARDIAN MUST SIGN FOR ALL PERSONS UNDER THE AGE OF 18)