Arrival Date *

MM

DD

YYYY

Arrival time *

Hour

Minute

Second

AM PM

Anticipated Departure Date *

MM

DD

YYYY

Owner / Skippers Name *

First Name

Last Name

Arrival Mode *

Via Boat

Via Car

Via Both / joint party arriving by boat and car

I hereby declare that the Certificate of Currency details I have provided are complete and accurate. The policy held is current and includes coverage for public liability of minimum $10 million (AUD) *

Yes

Land Visitors/Driver of Car *

If none, type 'Nil'

First Name

Last Name

QCYC Wharfage terms and conditions *

Acknowledge and agree to these QCYC's Wharfage terms and conditions QCYC WHARF - LICENSE CONDITIONS In these Conditions, QCYC means Queenscliff Cruising Yacht Club Inc. and capitalised terms are particularised in the Licence. Details: 1. Under this Agreement, QCYC grants to the Licensee a licence to wharf and locate the Vessel at the Wharf including the right for the Licensee’s crew, visitors and guests (“Invitees”) to use the adjacent walkways and waterways for ingress and egress to the Wharf, clubhouse facilities and amenities (“QCYC Facilities”) for the Term subject to QCYC's right of termination under this Agreement. 2. The Licensee (and where applicable all visitors and guests) must abide by this Agreement and the Wharf Rules (which are published on the QCYC website). Also, as Honorary Members of QCYC for the duration of their stay the Licensee and any associated persons must abide by the Rules and By-Laws applicable to QCYC Members whilst at the Club. A breach of this Agreement or the Rules or By-Laws may render the Licensee liable for fees or charges to remedy the breach and termination of this Agreement as QCYC determines. 3. By this Agreement the Licensee authorises QCYC to charge the nominated credit card account with any unpaid amount, including any fees or charges for a breach of this Agreement or the Rules or By-Laws. 4. QCYC may move the Vessel in the event of a storm, emergency or need for the Wharf (for example a regatta or event hosted by QCYC) without notice to the Licensee and at the risk of QCYC. 5. Any Wharf position described in this Agreement is not specific to this Agreement and QCYC may re-allocate another position on the Wharf to the Licensee in its absolute discretion upon further oral or written notice to you. 7. The Licensee is responsible for any damage to any part of the QCYC facilities arising directly or indirectly from any act or omission of the Licensee or the Licensee's associates." 8. The Licensee agrees to hold QCYC and its associates harmless and to indemnify QCYC, its officers, employees, agents and contractors against any claims or liabilities arising directly or indirectly as a consequence of any act or omission by the Licensee or the Licensee's associates in the use of the Wharf, QCYC Facilities or the Vessel. 9. The Licensee must at all times ensure that the Vessel strictly compiles with all relevant specifications (including any included in this Agreement) and applicable Australian standards, and complies with the QCYC Wharf Rules, including those relating to the operations of QCYC Facilities and its use. 10. QCYC gives no warranty of any kind whatsoever concerning the condition of the Wharf or other QCYC Facilities or any of its components and does not accept any responsibility for any claims or liabilities or injuries, damage or loss of property occurring in or near QCYC Facilities from any cause whatsoever. To the extent allowable by law, all other statutory and regulatory warranties are excluded. 11. Without limitation to clause 10, the Licensee agrees, acknowledges and accepts that use of the Wharf and/or QCYC Facilities: may be unsafe and hazardous to the Licensee, crews and invitees; and carries a risk of serious and material damage to their Vessel (including equipment, accessories and tenders) under certain weather and tidal conditions and, accordingly, the Licensee’s access, use and occupation of the Wharf and QCYC Facilities are at the Licensee's sole risk and responsibility. Further and without limitation, QCYC is under no obligation to board, intervene or relocate any unattended Vessel present on the Wharf but provided that if it does so determine in its sole discretion to board, intervene or relocate the Vessel for the purposes of reducing or preventing any loss or damage or potential loss or damage to the Vessel at any time, it will not be liable under any principal of law for any loss or damage caused by or occurring during such boarding, intervention or relocation of the Vessel by the QCYC, its officers, staff, contractors or volunteers or members. 12. The Licensee must insure against loss or damage of any kind to QCYC Facilities or the Vessel or any persons or other property associated with the Licensee or the Vessel. Details of the Licensee's current insurance are or shall be attached to this Agreement and further proof of currency and particulars of the Licensee's insurance must be produced upon request by QCYC. 13. This Agreement and the licence granted are not transferable and may not be sub-licenced without the consent in writing of QCYC which may be withheld absolutely or given on conditions as QCYC determines in its absolute discretion. 14. This Agreement provides a bare contractual licence to the Licensee to use the Wharf and the relevant parts of QCYC Facilities only and does not create any tenancy or any other estate or interest whatsoever. 15. Amounts shown in this Agreement are GST inclusive or exclusive as stipulated. If GST is imposed on any supply made under this Agreement a valid tax invoice must be provided and GST must be paid by the person receiving the supply. 16. This document comprises the sole agreement between QCYC and the Licensee subject only to any subsequent agreement in writing between them. 17. Both QCYC and the Licensee must do all things reasonably necessary to give full effect to this Agreement and to ensure that their associates do likewise

Acknowledge and agree to QCYC's Wharfage terms and conditions