Indemnity Form General

Indemnity Form

General
Which statement best suits you:*

I'm signing for myself (18 years and over only)I'm a parent/ carer signing on behalf of a child/ person in my care
Full Name of participant*

First NameLast Name
Type of Lesson you have booked*
This form is not for school groups, if you are a parent signing for a child attending on school excursion or weekly sport, please contact your school as they have a dedicated group waiver.
Date of lesson*

DayMonthYear
Date of first lesson booked
Lesson Start Time*

Hour Minutes

AM/PM Option
Date of Birth*

DayMonthYear
Email*
example@example.com
Mobile Number*
Example 0400555555 (no spaces)
Country of residence: *
Postcode (Australian residents only)
Example: 2095
Swimming Ability*

Weak/ Beginner (!! Please alert an instructor on the day of your lessons)CompetentAdvanced
Medical Conditions, along with medication: *
If there are no medical conditions or medication, please write N/A
Indemnity Declaration: I and / or my dependant wish to participate in a Surfing Australia Surf School with Manly Surf School and / or the Surfers Gym, High Performance Surf Center (HPSC) or surfing activity as indicated on this registration form. I understand that Surfing Australia and Manly Surf School take all possible care, but will not be held liable for any injury that my dependant or myself may sustain to our person or our property. I acknowledge that this activity is conducted in an environment controlled by a natural element and therefore I and my dependant will abide by all safety instructions.
By signing below I am acknowledging the Indemnity Declaration above. Signature: *

Clear
Date of signature*

DayMonthYear
Date
Newsletter

Yes, subscribe me to this newsletter.
If you are signing on behalf of a child/ someone in your care, name of person signing.

First NameLast Name
Should be Empty: