GoXp – DISCLAIMER FORM
Event Name _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Organizer Name _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ __ _ _ __ _ _ __ _ _ __ _ _ _
Date/Time _ _ __ _ _ _ _ _ _ _ __ _ _ __ _ _ __ _ _ __ _ _ __ _ _ __ _ _ _
Place _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _. _ _ _ __ _ _ __ _ _ __ _ _ __ _ _ _
I, do hereby acknowledge and agree for myself, my family as follows:
- Participation in the Adventure activity including traveling in vehicles, trekking, hiking, climbing, camping can result in injury or accidents. I acknowledge and I am fully aware of the inherent risks associated with participation in the Trip/Activity and I am solely responsible for my well-being.
- I understand that there is a certain level of unpredictability and uncertainty and discomfort associated with the any adventure activity. Things may not go as planned.
- I acknowledge that I am in good physical health and have read the difficulty rating and I am confident of my ability to take part in the said activity. I have no significant Injury, medical ailments or conditions that would counter-indicate any disability to take part in the outdoor activity.
- I agree to the Rules and regulations set by the organizer for our safety and I agree to adhere to those.
- I will follow the organizers instructions and I will not deviate from the planned route.
.
.
I confirm that I am 18 years of age or older and I acknowledge that by signing this disclaimer.
Full Name _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
S/O D/O _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ __ __ _ _ _ _ _ _ _ _ _ _ _
Age: _ _ _
Phone Number: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _
Address _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Blood Group _ _ _ _ _ _ _
Emergency Name & Contact _ _ _ _ _ _ __ _ _ _ _ _ __ _ _ _ _ _ __ _ _ _ _ _ _ _ __ _ _ _ _ _
Signature _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Date _ _ _ _ _ _ _ _ Place _ _ _ _ _ _ _ _