Mozambique: Quad and Motorcycle Tour - Entry Form

Surname:

First Names:

ID Number:

Gender:

Date of Birth:

Postal Address:

Telephone Number:

Cell Number:

Fax Number:

E-Mail Address:

Medical Aid Provider:

Medical Aid Number:

Medical Conditions/Allergies Etc.:

Emergency Contact Person:

Emergency Contact Numbers:

Group or Party Name:

Details of Quad or Bike and Age:

Any Other Relative Information:

WAIVER AND INDEMNITY
Participants take part at their own risk and agree that they shall have no claim whatsoever against the organizing body, any individual or official marshal, assistant, helper, or agent, sponsors or any local authority or their employees, in respect of any loss or damage whatsoever which participants may suffer arising from any injury to their person or loss or damage to their property as a result of or arising out of,
whether directly or indirectly, the participants arrival and departure from attendance at registration, during the tour or prize giving or other function thereof, any loss or damage to vehicles such as quads/motorbikes or other equipment however such loss may arise regardless of whether or not the same shall have been caused directly or indirectly by the negligence albeit gross, of one or of all the aforementioned parties.

Persons signing this entry form as guardian of a minor hereby consent to such minor being bound by the aforementioned parties to the extent. If any to which such minor is not capable of waiving his/her rights as stipulated above.

By submitting your information you acknowledge that you have read and accepted the terms of the above waiver and indemnity.