Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Contact Number *

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Emergency Contact *

(###)

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Date of Travel *

MM

DD

YYYY

ACKNOWLEDGEMENT & ASSUMPTION OF RISK & RELEASE OF LIABILITY *

I affirm that I have not had flu,cold,fever etc in the last 15 days

I affirm that I will not be under the influence of alcohol or controlled substance, and will not carry, use or consume these substances before or during the scheduled activities

Adventure activities/trips entails known and unanticipated risks that could result in physical or emotional injury, damage to self, to property and/or to third parties. I understand that such risks simply cannot be eliminated without jeopardizing the essential qualities of outdoor activities

Risks and dangers may be caused by other participants, or by accidents, or by the forces of nature, or other causes foreseeable or unforeseeable including but not limited to, adverse weather conditions, tidal conditions and currents, slips and falls and such other risks, hazards and dangers that are integral to recreational activities that take place in the outdoors

I have been advised that I must wear an approved personal flotation device at all times while on the water

Furthermore, SAHASEA guides have difficult jobs to perform. Safety is first priority although they are not infallible

I understand that I must be in good physical condition/health to participate in the activities. I have no known physical disabilities or health problems, which will present any risk to my participation in the activities

I understand that strenuous physical exertion may be required and Sahasea reserves the right to request proof of fitness or refuse to allow my participation in any classes, training or activity, even if I have already made payment for participation

Release *

On my behalf and on behalf of my personal representatives, executors and heirs, release and agree to indemnify, defend and hold harmless SAHASEA and all it's representatives from any and all injuries, losses or liabilities incident to my involvement or participation in these programs as provided above to the fullest extent permitted by law

Authorisation *

I hereby authorise any medical treatment deemed necessary in the event of any injury while participating in the activity. I either have appropriate insurance or, in its absence, agree to pay all costs of rescue and/or medical services as may be incurred on my/our behalf

I agree that any film or photographs of me/us, as participants, become the property of SAHASEA and may be used for promotional or commercial purposes