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DISCHARGE
OF LIABILITY
It is a fundamental condition of this
contract between ‘Spirit of Freedom Pty Ltd’, and its directors, employees,
agents and independent contractors (collectively and severally referred to as
“SOF” on the one part and
(Your Name):
on the other part, that to the extent permitted
by law “SOF” is hereby discharged and indemnified by my/our executor(s),
my/our administrator(s) and my/our dependent(s) from any liability for any
damage, death or injury whatsoever arising out of, or incidental to, this
diving trip and other services provided by “SOF”, whether or not such damage
or personal injury is caused or contributed to by “SOF”.
I acknowledge that I will be participating in
activities, which are undertaken for the purposes of recreation and involve a
significant degree of physical exertion or physical risk.
I further acknowledge that I am aware of the
risks of injury associated with my participation in this diving trip and
agree to voluntarily assume such risk.
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MEDICAL
STATEMENT (Strike out the incorrect answer)
Are you medically & physically fit to
dive/snorkel? YES/NO
I agree that:
1.
I have not suffered any
illness or injury that may affect my ability to dive or snorkel safely. YES/NO
2.
I am not currently suffering
or have ever suffered from illness or injury or condition relating to any
heart or lung disorder, asthma, epilepsy or insulin-dependent diabetes or any
other condition that is contraindicative to diving. YES/NO
3.
I am not currently suffering
from any illness or injury or condition, or taking any prescription
medication (other than contraception).
YES/NO
4.
If I am unsure about, or
cannot agree to points 1-3, I will present a Dive Medical clearance by a
doctor trained in Hyperbaric medicine. YES/NO
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STATEMENT
OF UNDERSTANDING
By inserting my name on the Discharge of
Liability and signing this form, I acknowledge that I have read, understood
and accepted the Discharge of Liability, the Cancellation Terms &
Conditions of Travel #1-#6, and agree to the Medical Statement.
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DATE:_____________
NAME:_____________________________________
SIGNATURE:_________________________________
(Your
signature or Parent or Guardian if under 18)
WITNESS:___________________________________
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