Kitesurfing Lesson Form

First Name:

Last Name:

Contact Email:

Contact Phone Number:

Emergency Contact Phone Number:

Do you have any medical details that would be relevant to your lesson, including but not limited to Epillepsy, Asthma, Heart condition etc.:

Yes No

If yes, please provide details:

If you have a gift voucher, please provide the voucher number here:

By completing this form and checking this box I agree that I have provided truthful and accurate information within this form to the best of my ability. I understand that this information is required by Adventure Sports Kitesurf Australia (ASKSA) to ensure my safety and satisfaction. I understand that ASKSA, its associated agencies and instructors cannot be held liable in the event of an incident or personal injury during the activity and agree to release said parties from any legal responsibility relating to the above activity. I participate having had the risks fully explained and accept responsibility for my participation. I agree to abide by the directions of the instructor/guide at all times to ensure both my safety and the safety of others. I understand that it is at the discretion of ASKSA to cancel the activity for any reason. If an activity has to be cancelled by ASKSA, I understand I will be entitled to a full or partial refund at the discretion of ASKSA. ASKSA may charge a cancellation fee of up 25% on any booking cancelled within 48 hours of the scheduled date. I understand that ASKSA keep all information on this form in accordance with the Privacy Act.

IKO Waiver:

IKO Affiliated Centre Name: Adventure Sports Kite Surf Australia

IKO Affiliated Centre ID: 908

In consideration for the courses and/or activities utilizing the facilities, ground IKO Affiliated Center, kiteboarding instruction, premises and equipment of Adventure Sports Kitesurf Australia, I hereby acknowledge and agree to the following:

I understand and acknowledge that kiteboarding activities have inherent dangers that no amount of care, caution, instruction, or expertise can totally eliminate. I expressly and voluntarily assume all risk of personal injury or death sustained while participating in kiteboarding activities whether or not caused by the negligence of the released parties.

I agree that I will operate the said kiteboarding equipment in a reasonable and safe manner so as not to endanger the lives of persons or property of any individual.

I confirm that I am an open water swimmer.

I am not under the influence of alcohol or drugs.

I am in good health condition and have no medical condition that may interfere with the practice of kiteboarding activities. I am not pregnant or nursing. I have no mental impairment that may affect my judgment of danger and information given during the practice of kiteboarding activities.

The school Manager and/or the Instructor has given me the full opportunity to ask any and all questions about kiteboarding activities and all of my questions have been answered to my total satisfaction.

I acknowledge that I have been given adequate opportunity to read and understand this document, that it was not presented to me at the last minute.

I further represent that I am at least 18 years of age or that as the parent or legal guardian I waive and release any and all legal rights that may accrue to me or to my minor child as the result of any injury that my son or daughter (minor) may suffer while engaging in kiteboarding activities.

I have read this waiver, fully understand its contents, and sign it of my own free will.

Confirmation:

I have read all the above terms and conditions, fully understand them and agree to them where indicated. I have completed this form myself in my own name, or am doing so on behalf of a minor as their legal guardian. I agree and understand that completing this form and submitting it here electronically I am providing an electronic signature consenting to and authorising this agreement.

Notes:

Kitesurfing Lesson Form

IKO Waiver:

Confirmation:

Your Order