1Tick.co.za online indemnities
  • HOME
  • SIGN UP / PRICING
  • FREE TEMPLATE
  • TRY OUR DEMO WAIVER
  • FEATURES
  • LOGIN
  • CONTACT
  • FAQ
Select Page

Segway Marketing and Tourism (Pty) Ltd – Segway Indemnity Form

It looks like your internet is very good, do you want to synchronize the data?
Total Signed: Total Returning:
   Thank you for completing our waiver form. Your submission for Segway Indemnity Form event was processed successfully.

Hi - welcome!

Please let us know if you are a new customer, or a 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?

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
Minor's gender
Minor's age group
Add New


Participants First name
Participants Last name
Participants Valid Email Address
Participants ID or Passport number or Date of Birth
Contact_number
Participants contact number
Emergency Contact person
Emergency Mobile Number
Country
City
Tour Option Selection
Date of actual trip please indicate in this format dd mm year
How did you hear about us?

By completing and submitting this form you are agreeing to the following:

INDEMNITY AND WAIVER

In this agreement:

“SMT” means collectively and individually as the context dictates: Segway Marketing & Tourism (Pty) Ltd t/a Segway Gliding Tours and their subsidiary companies, affiliates, employees, directors, members, agents, shareholders and property upon which the tours are conducted;

1.1 “Activity” means the Segway tours conducted by Segway Gliding Tours, including but not limited to, the use of the Segways, roads and pathways and being conveyed by any moving vehicle.

2. I, the undersigned person or the legal guardian of the child stated below (“my child”), hereby acknowledge and agree, on my own behalf or on behalf of the child taking part in the Activity, as the case may be, that I:

2.1 am aware of and understand the serious dangers and risks to my / (my child’s) health and bodily person and those of others, including possible serious injury, infection and death that are associated with the Activity which may arise from, among other things:

2.1.1 the fact that the Activity takes place at considerable speed and on a machine where falling is an inherent danger;

2.1.2 the presence of pedestrians, vehicles when crossing roads, winds and other natural hazards at the Activity; and/or

2.1.3 the fact that the tour takes place along uneven surfaces, obstacles and/or loose ground

2.2 adhere to the instructions provided at the safety briefing and understand the safety requirements

2.3 am aware that it is my / (my child’s) responsibility to physically control, steer and brake myself on the Segway for the full duration of the tour and failure to do so may result in serious injury or possible death to myself or others;

2.4 warrant that I am / (my child is) in good health, that I am not pregnant, and that I am prepared to act responsibly at all times;

2.5 warrant that I am the legal guardian of or have the full consent of the legal guardian or am an adult legally responsible for the child named below; that I have full legal capacity to contract for him/her and that he/she is over the age of 10

2.6 waive any and all claims of whatsoever cause or nature, howsoever arising against SMT, which I / my child might have arising out of any harm, injury, death or loss suffered whilst participating in the Activity and whether arising from an act or omission, malfunction and/or negligence on the part of SMT; and

2.7 indemnify and hold SMT harmless from any and all damages, liabilities and claims of whatsoever cause or nature which may be made by my spouse, children and/or any other dependent of mine or third party who may suffer any damages, including but not limited to personal injury, death, loss of support or any other loss, arising from any cause whatsoever relating to their or my partaking in the Activity (including but not limited to any act or omission, malfunction and/or negligence on the part of SMT).

2.8 warrant that I am not intoxicated nor under the influence of alcohol and agree that I will be held liable for any costs arising from injuries, accidents or damage to any property should I be found to be intoxicated or under the influence of alcohol.

  1. Accept that I am liable for any costs arising from damage caused by myself to other property / persons involved
  2. This agreement is governed by the law of South Africa.
  3. This agreement is binding on my executors, curators, liquidators and heirs.
  4. I accept that SMT may, in its discretion and without obligation to do so, arrange and pay for emergency medical treatment, for and on behalf of myself, spouse, my children, or relatives and/or any person accompanying me. I acknowledge that I will be directly responsible to reimburse SMT for these expenses.
  1. I agree that SMT may, in its sole discretion, refuse to permit me / my child to participate or continue to participate in the Activity at any time, for any reason and that SMT is not obliged to reimburse the fees already paid as a result of such non-participation in the Activity.
  2. I acknowledge and give permission to the corporations to use my, or that of my family’s images in all advertising and marketing publications, both print and / or electronic, and be stored electronically, available to all employees and clients of the corporations. I also agree that my and / or the images of my family will be freely available to use now and in the future without notice and any compensation.

COVID-19

Should your temperature exceed 37.8C or greater you won’t be eligible to participate in a tour.

 

 

Copyright 1Tick. All Rights Reserved.
Browser Terms ●Commercial Use Of Website ●Privacy Policy