Nick Wallace Surf Coach
Liabilty Waiver
Name of student
First name
Surname
Phone Number
Format: (000) 000-0000.
Email
example@example.com
Lesson Type(s)
Child group
Adult group
Private
Other
Ability Level
First Timer
Beginner
Intermediate
Advanced
Other
I, undersigned, agree with the following statements:
Release & Indemnity: My participation in the the lesson is entirely at my own risk and I agree to release and forever discharge Nick Wallace from all liability and claim that I may have arising from or in connection with my participation in the lesson
I understand I am solely responsible for the safety and wellbeing of myself. I understand that Nick does provide supervision, instruction, and assistance but the ocean can be unpredictable and while care is always taken participation comes with a risk
Warning: Participating in surfing can be inherently dangerous. I understand the nature and requirements of the lesson and acknowledge that serious accidents can and do happen which may result in me being seriously injured
Physical Fitness: I must not participate in the Program if I have any injury, disability, medical or health condition that may increase the risk of me becoming injured
Medical Treatment: If required, Nick will arrange medical or hospital treatment (including ambulance transportation) for me. I authorize such actions being taken by the Organisers and agree to meet all costs associated with such action.
I RELEASE ALL LIABILITY AND VOLUNTARILY EXECUTED THIS DOCUMENT WITH FULL KNOWLEDGE OF ITS CONTENT.
Date
-
Month
-
Day
Year
Signature (Legal Guardian if under 18)
Submit
Submit
Should be Empty: