Home | Up | GuideSpace | Youth Adventure | First Aid | Workshop Kit List | Indemnity Form

RIVER GUIDING WORKSHOP, 3-7 DECEMBER 2007, Zingela Camp

Although every effort will be made to ensure your safety on the skills development workshop you are about to undertake, the following statement must be signed by every participant. You do this at your own risk. If the participant is a minor under 18, both the person and his/her parent or guardian must sign. In order to assign you to appropriate tasks on the workshop, suited to your skills, we need to know more about you.

OWN RISK UNDERTAKING & PERSONAL DETAILS

I, the undersigned, do hereby state that I know and understand the risks of the excursion including activities on and off the river. I warrant that I am in good health and that I will take care and act responsibly at all times. I understand that in the nature of such skills development, there will be activities and exercises that do involve some danger. I will decide on each occasion whether to take part and will inform the workshop facilitator/s of my decision in the event that I do not wish to take part.

I voluntarily undertake the river safety, rescue and guiding activities and training at my own risk and will bring no action, claim or charge for liability or responsibility for any accident, injury, death or disfigurement, or damage to or loss of property, of whatever nature and howsoever arising, against Graeme Addison or Zingela River Safaris, its owners, guides, agents, helpers and other guests.

PLEASE COMPLETE ALL BOXES
SURNAME FIRST NAMES ID NO OR PASSPORT NO TEL / FAX & CODE
   

 

    

 

 

DESCRIBE THE NATURE OF YOUR WORK ON THE RIVER:

(eg guide, operator, general assistant, or other...)

 

 

 

 

 

 TEL & CODE EMAIL CELLPHONE
 

 

    
WHAT IS YOUR LEVEL OF BOATING, SAFETY AND RESCUE SKILLS NOW?

Boating:

Safety:

Rescue:

Any other comment here:

 

 HOME ADDRESS WORK ADDRESS

 

 

 

 AGE

MALE/FEMALE
   
ANY FIRST AID QUALIFICATION? (What level and the year qualified) ANY DRIVING LICENCES (type of licence/s and year) Your highest level of educational qualification (eg Matric, university degree - what it is, and year)
   

 

 

  

 

SIGNED BY PARTICIPANT:...........................................................................................

DATE:.......................................................................   PLACE:.........................................

If under 18, signed by parent or guardian:

NAME OF PERSON:.........................................................................................................

SIGNATURE:......................................................................................................................

THANK YOU. BRING THE COMPLETED FORM WITH YOU PLEASE.