Kougawildernis.co.za

REGISTRATION AND INDEMNITY

I, the undersigned,

FULL NAME AND SURNAME : ..........................................................................

HOME ADDRESS :..........................................................................................

TEL / FAX : ..................................................................................................

E-MAIL ADDRESS : .......................................................................................

Hereby,

1. acknowledge that my stay and any activities in which I or my family may participate on Kouga Wilderness Farms, including game drives, horse riding, hiking, abseiling, swimming and staying over in the guest house or camping site, involve a certain element of risk to personal safety and property;

2. waive and abandon all claims for damages arising from any cause whatsoever that may arise during my stay and I fully accept all risks relating thereto;

3. indemnify Kouga Wilderness Farms and its employees against all claims relating to personal injury or damage to or loss of property, irrespective of the nature or cause of such damage or injury;

4. warrant that I have the legal capacity to sign this document and that I may sign this document after all consents that I may by law require, have been obtained.

5. admit that I fully understand all the implications of this document.

Dated at KOUGA WILDERNESS FARMS on this  _ _ _ _ day of _ _ _ _ _ _ 20_ _

SIGNATURE:

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ASSISTED BY ME:

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REGISTRASIE EN VRYWARING

Ek die ondergetekende,

VOLLE NAAM EN VAN : ..................................................................................

POS ADRES :................................................................................................

TEL / FAKS : ................................................................................................

E-POS ADRES : ............................................................................................

1. Ek bevestig hiermee dat my en my gesin (indien van toepassing) se verblyf en aktiwiteite te Kouga Wildernis Kleinrivier Distrik Joubertina, waarby ingesluit mag wees wildbesigtigingsritte, perdry, stap, abseiling, swem en my verblyf in die gastehuis of kampeerterrein ‘n sekere mate van risiko insluit betreffende my persoon en my eiendom;

2. Ek doen hiermee afstand van enige moontlike eis om skadevergoeding voortspruitend uit watter oorsaak ook al wat mag ontstaan gedurende my verblyf op bogemelde eiendom, en aanvaar ek alle risiko betreffende sodanige skade;

3. Ek vrywaar hiermee Kouga Wildernis Plaas en sy werknemers teen enige eis betreffende beserings of skade of verlies van eiendom ongeag die aard van die oorsaak van sodanige skade of besering;

4. Ek bevestig hiermee dat ek die regsbevoegdheid het om die dokument te teken en dat ek gemagtig is om die dokument te teken en dat alle toestemmings wat deur die reg vereis mag word verkry is;

5. Ek erken hiermee dat ek die inhoud en die gevolge van hierdie dokument verstaan.

GETEKEN TE KOUGA WILDERNIS OP DIE  _ _ _ _ DAG VAN _ _ _ _ _ _ _   20_ _

HANDTEKENING :

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BYGESTAAN  DEUR MY :

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