Indemnity Form

Gaia Adventurers ‘s trips, programs and events are designed to provide an experience where each participant finds a level of challenge that enables them to push personal boundaries. We strongly adhere to the principal of “Challenge by Choice”. While every reasonable care has been taken to ensure programs are run to high safety standards, individuals may react differently – and perhaps unpredictably to different situations. Please assist us by filling in the following information.

Registration & Indemnity Release Form (to be filled by all participants & organizers joining the trip)

Event Name : ………………………………………………………………….

Event Date : ……………………………………………………………………

Name As in IC/Passport : ……………………………………………………

Address :  …………………………………………………………………………

Hand Phone: …………………………………………..

Email: ………………………………………………………

My Role in This Program is : Participant /Leader / Organizer

Date of Birth : ………………. Age :……………….. Sex : …..

Blood Type : ………………. Height : ………………..

Weight : ……………….

Please State Any Medical Conditions or Allergies that may require special attention

………………………………………………………………………………………………………………………………….

Indemnity Release Statement by the above named participant / coordinator.

I, _______________________________a participant/leader/organizer in the said Adventure Program understand that it is a form of adventure sports event that is set to take place in a harsh outdoor environment and I confirm that I am fully aware, understand and agree that being such type of event there are inherent dangers & certain elements unpredictability that accompany the excitement. As such, I agree to indemnify and keep indemnified Gaia Adventurers and all its organizers and leaders from any claims whatsoever and agree that I shall not hold Gaia Adventurers and its agents or leaders responsible nor be held liable for any personal injury, mental anguish, loss of any kind whatsoever howsoever caused that may occur during the event. And further agree to abide by all instructions issued by the facilitators/organizers of this event

…………………………………………………….

(Signature)

Date …………………….

* Please strike out whichever not applicable

** The complete form must be submitted before Adventure commences.

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19 Comments

19 thoughts on “Indemnity Form

  1. Dennis Kimathi

    Very informative.

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