Indemnity Form General

Indemnity Form

General
What are you doing today?
Which statement best suits you:
Full Name of participant

First NameLast Name
Date of Birth

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

DayMonthYear
Start Time

Hour Minutes
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.
Duration of Board Hire
Surfing Experience
Swimming Ability
Medical Conditions, along with medication:
If there are no medical conditions or medication, please write N/A
Board Hire Safety Acknowledgement
Stand-alone board hire is intended for customers who can safely swim in the ocean and use the hired equipment safely in the prevailing ocean conditions. Please read and acknowledge the following before proceeding.
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 acknowledge that I have read and understood the declarations and acknowledgements applicable to the activity I have selected, together with the Indemnity Declaration above. Signature:
Date of signature

DayMonthYear
Date
If you are signing on behalf of a child/ someone in your care, name of person signing.

First NameLast Name
Newsletter?
Should be Empty:

Indemnity Form

Board Hire Safety Acknowledgement