2009 Registration Details

Earthwave 2009 logo

GUINNESS WORLD RECORD ATTEMPT

Event Participant’s Declaration

Muizenberg Corner – 12.30pm Sunday 4 October 2009

DONATION – R50 – MINIMUM

I,  ………………………………………………………………………………………………………. (Full Name of Participant)

hereby declare that in applying to participate in Guinness World Record attempt (“the Event”) organised and run by the Kahuna Promotions (“KP”):

  • I ACKNOWLEDGE that there are inherent dangers associated with this event and my participation in the event, and that serious accidents can and do happen which may result in me being injured.
  • I DECLARE that I am medically and physically fit and free from impairment and able to participate in the Event.
  • I will at all times COMPLY with the instructions and safety procedures of KP and its staff.
  • To the full extent permitted by law, I agree to ABSOLVE AND INDEMNIFY KP, its directors, officers, agents and employees, the City of Cape Town, Surfing South Africa and its affiliates from and against any and all liability for injury, loss or damage however caused arising out of my participation in the Event.
  • I agree to RELEASE AND FOREVER DISCHARGE KP from all claims that I may have, or may have had but for this release, arising from my participation in the Event.
  • I AUTHORISE KP to arrange medical or hospital treatment (including, without limitation, ambulance transportation) if I am not available to do so and I INDEMNIFY KP for all costs associated therewith.
  • I AGREE that KP retains the right to utilise images of my participation in the Event for the purposes of promoting KP and the event.
  • I AGREE KP does not guarantee the Client against unforeseen eventualities or possible occurrences which may prevent KP from fulfilling its obligations. I hereby WAIVE my right to claim compensation of whatsoever kind in respect of such occurrences.

Participant’s Signature ………………………………………….           Date: ………/……………./ 2009

(Or parent or Legal Guardian’s signature if applicant is under 18 years of age)

“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 Declaration including the provision by me of a release and indemnity in the terms set out above”.

Parent’s Name: …………….……………………………… Parent’s signature: …..………………………

Please Note:  If you wish to receive a Certificate of Participation in the 2009 GWR attempt via email after the event and receive news on other Earthwave events, please provide us with an email address:

Email Address: …………………………………………………………………………………………………………..

©  2009 Kahuna Surfing Academy CC t/a Kahuna Promotions  All rights reserved