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Coaching Indemnity
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Coaching Indemnity
Ready to spill your beans?
Submit 1 form per person before your lesson!
Unicyclist
Name Surname
*
Phone Number
*
WhatsApp Number - if different to phone number
Email
*
ID or Date of Birth
*
Relevant Medical Info
*
Emergency Contact
Name Surname
*
Phone Number
*
WhatsApp Number - if different to phone number
Email
*
Unicycle Riding Skills
What skills do you want to focus on?
*
Base Level 1 - Mounting, Dismounting, Riding
Base Level 2 - Turning, Hopping, Idling
Base Level 3 - Ride a Figure-8, Ride Backwards
I'm ready for Freestyle tricks - Requires Base Levels 1-3
I'm ready for Extreme tricks - Requires Base Levels 1-3
I'm ready for Muni - Requires Base Levels 1-3
I'm ready for Road - Requires Base Levels 1-3
Medical Aid Details
Do you have medical aid?
*
Yes
No
Medical Aid Name & Plan
*
Plan Number
*
Terms & Conditions - the legal stuff
*
I acknowledge that by signing/ agreeing to this form, I am assuming risks and agree to indemnify, not to sue and release from liability Donna Kisogloo (ID 7709170075088), Shaun Devenish (ID 7902025114083), Meerenhof Properties (Pty) Ltd (Reg No 2013/015642/07) and its shareholders, directors, employees, agents and/ or any parties associated with them (“ the Indemnified Parties ”) and that I am giving up substantial legal rights;
Fully understand and assume the risks associated with partaking in unicycling, including, by way of example and not limited to, the dangers of collision with pedestrians, vehicles, other athletes and racers, fixed or moving objects, the dangers arising from surface hazards, including potholes, equipment failure, inadequate safety equipment, the athletes own negligence, the negligence of others and weather conditions, the possibility of serious physical and/or mental trauma or injury, or death associated with unicycling and competition;
For myself, my heirs, executors, administrators, legal representatives, assignees, successors in interest, hereby agree that none of the Indemnified Parties shall be liable for any loss or damage sustained as a result of my/our death, injury or illness or for any loss or damage to any property occurring within or arising from my/our participation in any phase of the training program hosted by Donna Kisogloo and Shaun Devenish and/or while present on the premises of Meerenhof Properties (Pty) Ltd (“ the Property ”) and/or while participating in any activities hosted on the Property, however caused, and whether allegedly due to the act or omission, negligence or otherwise of the Indemnified Parties or arising from the use of any facilities supplied or from alleged defect in any;
Agree that, if and to the extent that any of the Indemnified Parties may be found liable notwithstanding the above, such liability shall be limited to an aggregate amount of R1000 in total.
This is a contract with legal and binding consequences.
I have read it carefully before signing and I understand what it means and what I am agreeing to by signing.
I have read the T&C's
Do you agree to our T&C's?
*
No - I won't be doing the lesson 🙁
Yes - Let's do the lesson 🙂
Date
*
MM slash DD slash YYYY
1039
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