Surf Connect Registration, waiver and indemnity form rwi260831a

ACTIVITY

Is this your very first lesson?

If not, please tell us when & where you had your previous lesson(s), and what level you reached

Full Name

PrefixFirst NameLast Name

Mobile Number

First 4 digitsRemaining numbers

E-mail

Address

Street Address

Street Address Line 2

CityState / Province

Postcode

Gender

Date of birth

DayMthYear

Today's date

Date

Age

Weight (kg)

Helmet size

Shirt size

Waist size

Payment

Order or Voucher Number:

If payment was not made by yourself, name of person who made payment:

SERVICE

If this is for a kitesurf RENTAL, do you hold an IKO certification card?

Date & Start time

DayMonthYearHourMinutesAM/PM Option

End time

:HourMinutesAM/PM Option

Have you filled one of these forms before?

Have you participated in a Surf Connect activity before?

Please state activity, rough date and instructor's name if you remember, or if you had lessons elsewhere, please put details here

If you have your own equipment you would like to use in the lesson, what is the Brand, Model, Year and Size(s)?

Can you swim unaided and of good health?

Do you have any medical conditions, illnesses, disability or injuries that may affect the safety of your participation?

Emergency contact

Name

Street Address Line 2

Telephone

Any notes or comments you wish to advise the instructor?

WAIVER, RECREATIONAL SERVICES RELEASES, INDEMNITY, POSITION OF SURF CONNECT, RISK WARNING, INSURANCE, CONSENT, TERMS & CONDITIONS — these must be read and agreed to before the form is submitted, as submission indicates your agreement to our booking terms and conditions, which are listed here, and on our website www.surfconnect.com.

I understand that Surf Connect is acting only as the booking agent and is not liable for any injuries resulting from the obvious risks associated with this 'dangerous recreational activity'. I acknowledge that this activity involves an element of danger and unpredictability due to its reliance on the nature of the sea and weather. I also acknowledge that there is a risk of injury, including permanent and serious physical injury. If someone is injured, no liability is imposed on any of the parties involved. In consideration of my or my child's right to participate in these activities, I acknowledge and agree to assume all risks inherent in them. I also agree to hold Surf Connect, its contractors, instructors, servants and agents, free from any and all liability, claims or demands, no matter how caused, whether by or through their negligence, for any injuries and/or expenses. I also agree to indemnify them from all claims arising from my or my child’s participation in these classes.

I also accept full responsibility for all the equipment hired to me under this agreement. In the event of any breakages or loss, the user will be liable for the full replacement cost.

I have been advised to check whether my home/private insurance policy covers self-injury, injury to others, and loss or damage to equipment, and to seek relevant insurance cover if it does not.

I also give consent to pictures taken during the activity being used for promotional purposes on Surf Connect's social media channels and website.

By agreeing to the terms and conditions of this form, and also that on our website www.surfconnect.com, I also accept the release of liability, waiver of legal rights, and assumption of risk. I declare that I am a competent swimmer and am in good health with no previous or existing injuries that may affect my safety when participating in the activity in question.

Registration, waiver and indemnity form rwi260831a

Submission failed. Either the criteria to participate have not been met, or the form has been completed incorrectly. Please try again. If submission fails again, please contact Surf Connect for assistance.