Shockwave Adventures Zambezi White-Water Rafting It looks like your internet is very good, do you want to synchronize the data? Total Signed: Total Returning: Sync data Thank you for completing our waiver form. Your submission for Zambezi White-Water Rafting event was processed successfully. Hi - welcome! Please let us know if you are a new customer, or a returning customer.... Make a selection New customer Returning customer (please use same email address). Name * Surname * email * Are you a new customer? I'm a new customer Are you completing this on behalf of a minor? Make a selection No Yes For legal Guardian (All fields compulsory) Guardian Full Name and Surname * Relationship to minor * Guardians valid Email Address * Guardians contact number (also for emergencies) * Minor 1 Remove Minor's name * Minor's Surname * Minor's date of birth * Day1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 MonthJanuary February March April May June July August September October November December Year2025 2024 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 Minor's gender * Make a selection Male Female Minor's age * Make a selection 123456789101112131415161718 Any medical conditions * Make a selection Yes No INSERT DETAILS HERE Add another minor Participants First name Participants First name * Participants Last name Participants Last name * Participants Valid Email Address Participants Valid Email Address * Participants ID or Passport number or Date of Birth Participants ID or Passport number or Date of Birth * Contact_number Contact_number * Participants ID or Passport number (Minors - date of birth) Participants ID or Passport number (Minors - date of birth) * Emergency Contact person Emergency Contact person Emergency Mobile Number Emergency Mobile Number Emergency Contact Number Emergency Contact Number Country Country * Gender Gender * Age Group Age Group CAN YOU SWIM? CAN YOU SWIM? * ANY MEDICAL HISTORY ANY MEDICAL HISTORY * DO YOU REGULARLY CARRY ANY MEDICATION? DO YOU REGULARLY CARRY ANY MEDICATION? * IF YOU ANSWERED YES PLEASE STATE IF YOU ANSWERED YES PLEASE STATE DATE OF ACTIVITY DATE OF ACTIVITY * How did you hear about us? How did you hear about us? * Do you possses a Valid Covid Travel Certificate? Do you possses a Valid Covid Travel Certificate? * By completing and submitting this form you are agreeing to the following: The Zambezi River in the gorges below is classified as a Grade Five river. The official definition of a grade 5 river, as defined by the book of the British Canoe Union is as follows: “Extremely difficult, long and violent rapids, steep gradients, big drops, pressure areas” I acknowledge that I am aware that the consequences of an accident whilst rafting on the Zambezi River can be serious. I understand that in the course of a river descent, I can be thrown from the boat and fall into the water at any point on the river. I declare that I am not under the influence of alcohol or drugs and that I will not use any for the duration of the activity. I acknowledge that I will be required to walk down and up a gorge in order to access and exit from the Zambezi River. I have been made aware that this is steep, rocky and may be slippery. I have also been made aware that after the raft trip, I will be transported to Victoria Falls by vehicle. I will follow and comply with each and every instruction given by the Company, its guide or instructors, its employees or any of its agents. I acknowledge that this agreement sets out the full basis of the relationship between the Company and me. The company will explained/illustrated and/or demonstrated to my satisfaction, the nature of risk and dangers of rafting and I accept these risks and accept that all the terms and conditions of this indemnity are clear and understood by me. I hereby indemnity the Company, its directors, its employees, its agents and contractors in respect of any claim for injury to myself whether fatal or otherwise, or loss/damage of my property which may occur during the rafting trip on the Zambezi River and/or my return by vehicle to Victoria Falls town. I grant the Company the right to use any photographs and or videos in which I may appear for advertising and marketing purposes of which I will not claim remuneration from the said company. I DECLARE THAT I HAVE READ AND FULLY UNDERSTOOD THE CONDITIONS OF THIS INDEMNITY I agree to these terms and conditions
