Breathe Conservation Indemnity Form

LIVE DEEPLY, TREAD LIGHTLY

Breathe Conservation Indemnity Form

Before partaking in any of our activities, please carefully read the indemnity form below, complete the form fields and send it.
You will get a copy emailed to you for your records.
* We do not store these indemnity forms online.

ACTIVITY*

(name to be entered here eg: reef clean up)

Please read carefully and acknowlege acceptance below:

I, (Full Name)*

Cell Number*

Email address*

do hereby in my personal capacity and / or in my capacity as parent/guardian of

Name of minor child

acknowledge and agree as follows

I fully understand that the activities and exercises of the Breathe snorkel/ reef, beach cleanup and marine guide development programme require vigorous physical activity, and I hereby represent and confirm that my / the aforementioned minor child’s (hereinafter referred to as “the child’s”) skill level, fitness, physical condition and health permits me/him/her to fully participate in Breathe’s programmes or events without undue risk to my/his/her wellbeing.
I fully understand and accept the risk involved in Breathes events, which includes open ocean swimming without close supervision and with no ‘back up’ craft on hand, in areas which may or may not have shark nets and which may result in me/the child coming into contact with the variety of marine life that may inhabit such waters. I accept that all these risks have been explained to me/the child, and that I/he/she nonetheless voluntarily undertake(s) to participate in Breathes swimming programme and assumes all risks involved.
I understand that a Breathe representative may take me/the child to a swimming activity, travelling by motor vehicle. I consent to this transport, and accept all risks involved
I authorize Breathe to obtain, provide or perform any emergency medical assistance which Breathe, its representative(s) or employee(s) deem(s) necessary, in the event of an injury or accident of whatsoever nature, and I agree to be responsible for all necessary and reasonable medical expenses incurred in this regard.
I, in my personal capacity or in my capacity as parent/guardian of the child, and my/his/her executors, heirs, assigns and successors in title, hereby indemnify and hold harmless Breathe and/or any of its representatives and/or employees and/or insurers, from any claims, demands, liability, injury, loss (including loss of life) or damage from any cause, which I/the child may suffer as a result of my/his/her participation in the Breathe programmes.
I confirm to the best of my knowledge that I do not currently have Covid or am experiencing any Covid type symptoms."
"I understand and agree that Breathe may take photographs or videos during this event, in which I may appear, and which Breathe may use for marketing and/or social media purposes."
I confirm that I am fully aware of the legal consequences of signing this document and declare that I am duly authorised to enter into this agreement on my/the child’s behalf.
I hereby consent to the Indemnified Party and its officers, employees, agents and third party service providers lawfully collecting, processing, storing and transferring my personal information, as defined in the Protection of Personal Information Act 4 of 2013 (POPI) in accordance with POPI and to process such information in insofar as necessary.
The parties agree that this agreement may be signed electronically in terms of the Electronic Communications and Transactions Act 25 of 2002 (ECTA) and that in terms of ECTA, the agreement, in electronic format, is not without legal force and effect merely because it is wholly or partly in the form of a data message.

Signed at (place name)*

Signed on: (Today's Date)

I have read and understand the indemnity document and agree with its terms*

I agree

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