Walkin On Water Participation Declaration Please ONLY complete this form if you have made a booking with Walkin’ On Water Surf School. If you have not yet booked in, you can BOOK IN HERE. Step 1 of 4 25% Participant's Name* First Last AgePlease enter a number from 5 to 100.Age must be supplied if participant is under 18 years old.Phone Number*Email* Where the participant is under 18 years of age this form must be signed by the participant’s parent or legal guardian. I am the parent or guardian of the applicant. I expressly agree to be responsible for the applicant’s behaviour and agree to personally accept the conditions set out in this application.Address Street Address Suburb State Postcode AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Medical Information(Confidential) Please indicate any medical conditions that instructors should be aware of. Upon arrival, please ensure you inform your surf coach of any important medical information or relevant conditions. Please note, this will be kept completely confidential and is required only from our duty of care perspective. Lesson Date:* DD slash MM slash YYYY Please select the date of the lesson (or start date of the program) you have booked with Walkin On Water.How did you hear about us please? WoW Brochure Truck Accommodation Online Search Referral Yellow Pages Surfing QLD Local Area Map Surf Shop Other Surf Shop Name: Are you on holiday on the Gold Coast? Yes No Where are you staying? Consent & Agreement* I have read, understood, acknowledge and agree to the above declaration including the warning, release and indemnity.Walkin On Water Surf School's surfing programs can cover not only the technical skills of surfing but may also include other information and training, depending on the programs, such as surf safety, surf awareness, surf etiquette, information about the sport of surfing, opportunities in the industry, equipment and possibly a range of other surfing, surf training and surf fitness information. In consideration of the Surf School accepting my application to participate in the Program, below I acknowledge, understand and agree that: 1. "Surf School" for the purposes of this declaration means and includes Walkin’ on Water, and respective directors, officers, members, servants or agents. 2. Warning: Participating in the Program can be inherently dangerous. I understand the nature and requirements of the Program and acknowledge that serious accidents can and often do happen which may result in me being seriously injured or even killed. I have voluntarily read and understood this warning and accept and assume the inherent risks in participating in the Program. 3. Physical Fitness: I must not participate in the Program if I have any injury, disability, medical or health condition that may increase the risk of me becoming injured unless I have told the Surf School about it and they have authorised me to participate. I declare that I am medically and physically fit and able to participate in the Program and I will immediately notify the Surf School of any change to my fitness and ability to participate. 4. Instructions: I will at all times comply with the instructions and safety procedures of the Surf School. 5. Medical Treatment: If required, the Surf School will arrange medical or hospital treatment (including ambulance transportation) for me. I authorise such actions being taken by the Surf School and agree to meet all costs associated with such action. 6. Release & Indemnity: My participation in the Program is entirely at my own risk and I agree to: (a) release and forever discharge the Surf School from all liability and Claims that I may have or may have had but for this release arising from or in connection with my participation in the Program; (b) indemnify and hold harmless the Surf School to the extent permitted by law in respect of any Claim by any person including but not only another participant in the Program arising as a result of or in connection with my participation in the Program. In this clause 6 “Claims” means and includes any action, suit, proceeding, claim, demand, damage, penalty, cost or expense however arising (including negligence, trespass to the person or for breach of implied terms in the sale of services under section 60 and 61 of the Australian Competition and Consumer Act (2010) Cth and equivalent provisions contained in State sale of goods or fair trading legislation). 7. Identity: Photographic and or visual images taken by the Surf School of my participation in the Program may be used for general promotion of the Organiser's activities 8. Privacy: I understand that the information provided by me in this form is necessary for the operation of the Program. I acknowledge and agree that the information will only be used for the objects of the Surf School and to provide me with information pertaining to the Program. I understand that I will be able to access my information through the Surf School upon request. If the information is not provided I might not be permitted to participate in the Program. The completion of your email address enables us to email you various information throughout the year. If you do not want to receive email from WoW, please do not fill in your email address or you can reply Unsubscribe to the emails and you will be removed from our list.Signature* Home Terms & Conditions Contact Us
