Skip to content
Search for:
SERVICES
GALLERY
REVIEWS
CONTACT US
EVENTS
ABOUT US
Half Day Snorkelling Disclaimer
mucha
2021-01-08T13:48:17+10:30
Mucha Adventure - Snorkelling Information and Waiver
Snorkelling Checklist and Waiver - This information is relevant to ensure we can help look after you in case of an unexpected event occurring.
Please enable JavaScript in your browser to complete this form.
1
Mucha Adventure - Snorkelling Information and Waiver
2
Name
*
First
Last
Email
*
Phone
*
Swimming Ability
*
100m +
50m
25m
Non swimmer
Snorkelling Ability
*
Never snorkelled before
Snorkelled once or twice - beginner
Snorkelled a few times - novice
Snorkelled many times - advanced
Wetsuit Size - Ladies (limited sizing)
*
Small
Medium
Large
Other - NOTE unfortunately we currently don't carry sizes outside the above range
Foot size (for fins) Ladies
*
Small
Medium
Large
Health and Fitness
*
I do many physical activities
I do some physical activities
I do very little physical activity
Medical Information - Do you suffer from any of the below?
*
Asthma
Heart Condtion
Epilepsy
Allergies (Including bee stings, food etc)
Diabetes
No medical conditions that are relevant to this activity
Any other medical conditions that may be relevant to undertaking this activity?
Any relevant information must be included
Name of emergency contact
*
First
Last
Phone Number of Emergency Contact
*
Relationship of Emergency Contact
*
Next
Terms and Conditions - The following terms and conditions apply. In no activity, including, but not limited to the above mentioned activity, shall this group or the groups organiser be liable for any damages whatsoever, whether direct, indirect, general, special, compensatory, consequential, and/or incidental, arising out of or relating to the conduct of you or anyone else in connection to Mucha Adventure, including, without limitation, bodily injury, emotional distress, and/or any other damages resulting from this or any other activity undertaken within the group. You acknowledge that you are physically and mentally capable of undertaking the activity without any risk to your safety and the safety of others in the group. Mucha Adventure reserves the right to withdraw services from customers that are impacting on the enjoyment or safety of other customers but not limited to the physical, medical or mental inability of customers to undertake the arrangements of the event/tour, unsocial or unruly behaviour, or the carriage of prohibited substances or materials. Waiver Assumption of Risk and Complete Release of Liability I UNDERSTAND THAT THE PURPOSE OF SIGNING THIS DOCUMENT IS TO EXEMPT AND RELEASE MUCHA ADVENTURE OR ITS ORGANISERS AND PARTICIPANTS HEREINAFTER AS REFERRED TO AS “RELEASED PARTIES” AND TO HOLD THESE ENTITIES HARMLESS FROM ANY AND ALL LIABILITIES ARISING AS A CONSEQUENCE OF THE FOLLOWING, OR ANY OTHER ACTS OR OMISSIONS ON THEIR PART, INCLUDING BUT NOT LIMITED TO ANY NEGLIGENCE OF ANY TYPE. 1. I understand that I have a duty to exercise reasonable care for my own safety and the safety of others and I agree to do so. 2. I assert that I am physically fit to undertake the above activities and I will not hold the released parties responsible for any problems (medical, accidental or otherwise) which occur whilst undertaking these activities. 3. I understand that I must not be under the influence of alcohol or non-prescription drugs when undertaking any activities organised and managed by Mucha Adventure. 4. It is my intention by this instrument to give up my right to sue all persons or entities referred to herein, whether specifically named or not and it is also my intention to exempt and release all released parties and to hold these entities harmless for any or all liability for personal injury, property damage or wrongful death. I assume all risk in connection with undertaking the above activity and the organisation of this activity. 5. I have carefully read this contract in its entirety, fully understand its contents, and agree to the terms and conditions of this contract on behalf of myself. This document constitutes the final and entire agreement between released parties and the undersigned. There are no warranties expressed or implied which extend beyond the description of the activity listed on this form. This is a complete release of liability and a legally binding contract. I have read this agreement and I am aware that it is a release of liability and a contract between myself and the Released Parties, I sign it of my own free will and agree to be bound by it, from the date of my signature, forever into the future. Please check both boxes to confirm
*
I have read and agree to the above Terms and Conditions
I have answered all questions truthfully
Signature - use your mouse or finger to create your signature.
*
Clear Signature
Date (dd/mm/yyyy)
*
Submit
Go to Top