Camp Aquarius Camper Registration Form
Camp Aquarius 2023
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Campers Name: *
Gender *
Date of Birth *
MM
/
DD
/
YYYY
Address
eMail *
Telephone Number (Home)
Telephone (Mobile) *
How well can s/he swim? *
Excellent
Poor
Name of Parent/Guardian
Address of Parent/Guardian
Telephone Number (Cell)
Emergency Contact Name *
Emergency Contact Telephone Number *
Do you or have you suffered from any mental and/or physical disease, illness or disability which would render you unfit for any water sports activities, including kayaking, swimming or diving? *
If Yes, please state:
Do you suffer from any type of asthmatic condition/illness?
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*If yes please state:
The company shall not be liable under any circumstances whatsoever, to any person for any injury, loss or damage maintenance and cure arising from any injury and or illness sustained by such person while engaged in diving, kayaking, swimming, snorkeling or any water sports caused or occasioned by reason of the perils or dangers of the sea or by reason of the act, omission, negligence or default of any other kayakers, snorkelers, person or persons engaged in water sports or as a consequence of an illness or disease or disability which renders such person or persons unfit for diving, kayaking, swimming, snorkeling or any other water sports. Agreement below grants Aquarius Watersports and its representatives the right to take photographs of me and my property in connection with the above-identified activities, and authorises the copyright, use and publish of the same in print and/or electronically. I agree that to the use of such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content. *
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