River Swim Liability Form

Today's Date

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DD

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Swimmer's Name *

First Name

Last Name

Your Mobile Phone Number Please *

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Your Date of Birth *

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DD

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Parent / Guardian Name if swimmer under 18

By adding your name here you are acknowledging that you give consent for your child to participate in the River Swim section of the retreat. You are also acknowledging and accepting the risks and cautions that your child will be subjected to by joining in this activity.

First Name

Last Name

Name of Emergency Contact *

First Name

Last Name

Emergency Contact Phone Number *

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Acknowledgement of Risk *

I acknowledge that participating in a river swim involves inherent risks, including but not limited to: Strong currents and changing water conditions Slippery, uneven surfaces including a rocky river bed. Exposure to natural elements and wildlife Potential for injury from other participants or equipment I understand that while a risk assessment has been conducted and safety measures are in place, not all risks can be eliminated.

I acknowledge and accept these risks

I have chosen not to swim this time

Assumption of Risk *

I voluntarily choose to participate in the river swim and assume all risks associated with this activity. I certify that I am physically fit, a competent swimmer and have no medical conditions that would prevent my safe participation.

I confirm that I can confidently swim 100m unaided

Release of Liability *

In consideration of being allowed to participate in the river swim, I hereby release and hold harmless Harriet Getley, Pippa Newman, and their volunteers from any and all claims, liabilities, or demands arising out of or related to any loss, damage, injury, or death that may occur as a result of my participation, whether caused by negligence or otherwise.

I release the organisers of this retreat from all liability arising out of the river swim

Medical Treatment *

I consent to receive medical treatment deemed necessary if I am injured or require medical attention during the river swim. I agree to be responsible for any costs associated with such treatment.

I agree to necessary Medical Treatment

Acknowledge and Accept *

I have read and understood this liability waiver. I acknowledge that by signing this document, I am waiving certain legal rights, including the right to sue. I sign this waiver freely and voluntarily.

I acknowledge & accept this waiver liability

I confirm that I have clicked on the red button below and have read the River Swim Guidelines