Indemnity Form Participant 1* First Last Participant 2 First Last Participant 3 First Last Date* Date Format: MM slash DD slash YYYY Phone*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code 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 Have you been in a Covid-19 Hot Spot in the past 14 days?* Yes NoConsent* I agree to the below mentionedI fully indemnify Australian Jet Boats Pty Ltd, trading as River to Bay (including its directors, employees, agents, subcontractors, associated and assignees) from and against all claims, actions, causes of action by or on behalf of any other person and all judgements, costs of litigations and fees which may in any way result from participating in any tour or charter conducted under the business name River to Bay, or having any connection with the commercial activities of Australian Jet Boats Pty Ltd. Participants must be 18 years of age or older and sign this Agreement personally or by parent or Guardian if under 18 years. By signing this document, I honestly declare that: 1. I am aware that I am undertaking an adventure tour boat by which has inherent dangers of distress, exposure to the element, injury or drowning; 2. I have considered my health and ability to participate in the proposed tour. I declare that my health and safety and that of other participants will not put me at risk by me taking part. I will make the tour leader aware if I have any current medical conditions that may affect or limit my ability to participate in this tour – for example, but not limited to, chronic sea-sickness, back or next injury, cardiac conditions or pregnancy 3. I acknowledge that in undertaking any tour or boat charter conducted by River to Bay both my property and my person re solely at my own risk 4. I acknowledge that the owner of River to By, Australian Jet Boats Pty Ltd, does not warrant either expressly or impliedly, my safety or the safety of others whilst participating in any other tour or charter 5. I agree to pay for any loss, damage or injuries caused by or resulting from my use of intended or attempted use of any of the equipment owned by Australian Jet Boats Pty Ltd, or by my conducted in general while participating in a River to Bay tour or charter 6. I agree to abide by all rules and regulations established by Australian Jet Boats Pty Ltd and any directions regarding the use of equipment or participation in tours or charters offered by River to Bay 7. I agree to use personal protective equipment provided for each activity as instructed by the tour leader 8. I am a competent and confident swimmer, and if not have specifically advised the tour staff of my level of swimming ability 9. I am over the age of 18 years. If under the age of 18 years, my Parent or Guardian will sign this Agreement on my behalf 10. I agree to any promotional use of my image whilst participating in a River to Bay tour or charter. I will make the operator aware if I have any objection to this agreement All participants over the age of 18 must sign this indemnity form. Participants under the age of 18 must be signed for, and supervised by their parent or guardian.