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 Participants Name Participants Surname Participants 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 participant Guardian ID Number or passport number Guardians valid Email Address Guardians contact number (also for emergencies) Minor 1 Remove Minor's name Minor's Surname Minor's date of birth 1 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 January February March April May Jun July August September October November December 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 Add New Participants First name Participants Last name Participants Valid Email Address Participants ID or Passport number or Date of Birth Contact_number Participants ID or Passport number (Minors - date of birth) Emergency Contact person Emergency Mobile Number Emergency Contact Number Country Make a selection South Africa Australia Germany United Kingdom United States Netherlands India Namibia Afghanistan Albania Algeria American Samoa Andorra Angola Antigua and Barbuda Argentina Armenia Aruba Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil British Virgin Islands Brunei Darussalam Bulgaria Burkina Faso Burundi Cape Verde Cambodia Cameroon Canada Cayman Central Chad Channel Islands Chile China Colombia Comoros Congo Costa Rica Cote d\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\'Ivoire Croatia Cuba Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini Ethiopia Faroe Islands Fiji Finland France French Polynesia Gabon Gambia Georgia Ghana Gibraltar Greece Greenland Grenada Guam Guatemala Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea Dem. People’s Rep. Korea Kosovo Kuwait Kyrgyz Lao Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao China Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia Moldova Monaco Mongolia Montenegro Morocco Mozambique Myanmar Nauru Nepal New Caledonia New Zealand Nicaragua Niger Nigeria Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Puerto Rico Qatar Romania Russia Rwanda Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore St Maarten (Dutch part) Slovenia Solomon Islands Somalia South Sudan Spain Sri Lanka St. Kitts and Nevis St. Lucia St. Martin (French part) St. Vincent and the Grenadines Sudan Suriname Sweden Switzerland Tajikistan Tanzania Thailand Timor-Leste Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates Uruguay Uzbekistan Vanuatu Venezuela Vietnam Virgin Islands (U.S.) Yemen Zambia Zimbabwe Other Gender Make a selection Male Female Age Group Make a selection 1 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 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100+ CAN YOU SWIM? Make a selection Yes No ANY MEDICAL HISTORY DO YOU REGULARLY CARRY ANY MEDICATION? Make a selection Yes No IF YOU ANSWERED YES PLEASE STATE DATE OF ACTIVITY How did you hear about us? Make a selection Brochure Word of mouth Printed advert Internet search Social media Road Signage Other 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
