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Idemity Form

This document is an indemnity statement for children and teens participating in activities organized by Tree of Life Adventures. It must be completed by parents or legal guardians and releases Tree of Life Adventures from liability for any injuries not covered by insurance. The parents agree not to sue or hold Tree of Life Adventures responsible for any expenses related to injuries. Contact information is provided in case of emergency as well as medical details like allergies and current medications.

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tokoti
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107 views2 pages

Idemity Form

This document is an indemnity statement for children and teens participating in activities organized by Tree of Life Adventures. It must be completed by parents or legal guardians and releases Tree of Life Adventures from liability for any injuries not covered by insurance. The parents agree not to sue or hold Tree of Life Adventures responsible for any expenses related to injuries. Contact information is provided in case of emergency as well as medical details like allergies and current medications.

Uploaded by

tokoti
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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16 A Garidner Road P.O.

Box GD 145
Ruwa Greendale, Harare 0772 334 586 08677114899

[email protected]

www.treeoflifeadventures.co.zw

___________________________________________________________________________________________________________

Indemnity Statement for Children and Teens

Although Tree Of Life Adventures is covered by public liability, this indemnity statement must be completed
by parents or legal guardians in order for your child to participate in activities organized by Tree Of Life
Adventures on behalf of _________________________(School
Arundel School or booking name)

From ________________________To ___________________________

Mr and Mrs Tokoti


We the undersigned parents/guardian_______________________ of
____________________________________(Full Name of child) a minor of valuable consideration do
hereby release Tree Of Life Adventures and his employees and any other entity hereinafter collectively
called “Tree Of Life Adventures” from all actions, claims or demands which we may hereafter have either
individually or as guardians, arising from injuries to said minor not covered by insurance. We agree not to
sue, and to indemnify and hold harmless, Tree Of Life Adventures from any loss or expenses it may incur
because of injuries to said minor. In the event only one parent / guardian signing, the plural pronouns shall
be deemed as singular.
SIGNATURES _________________ ___________ _________________ ___________
Father/guardian Date Mother/guardian Date

0775017569/ 0772778026
Contacts details incase of an emergency________________________________

Contact name and details of doctor ____________________________________

Medical aid and medical aid number ___________________________________

Dietary requirements __________________________________________________


11/02/2005
Birth date____________________
N/A Can not swim
Allergies to medicine ________________________Swimming ability _____________

Is your child taking any medicine, if so what medicine is he/she taking and what dosages should be
given to him/her. N/A

_____________________________________________________________________

NB* Please ensure that the teacher / parent in charge is given the medicine and instructions on
dosages
NB* If your child suffers from asthma please send out their pumps.

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