Expression of Interest Participant Form

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EMR Community Guided Snorkel Day

First Name *

Last Name *

Email *

Phone Number *

Emergency Contact Name *

Emergency Contact Phone Number *

Date of Birth *

YYYY

How Many Participants in Your Group *

Declaration

I hereby acknowledge the risks associated with snorkelling. I fully understand and have read the potential risks and risk reduction strategies. I agree to disclose any medical conditions on this form and to my assigned guide. I acknowledge that it is my responsibility to have medication on hand. I agree to follow the instructions of my guide and also agree for my photo to be taken and used for promotion (including press releases and on social media). I have read the paragraph above and the laminated Risk Management diagram for the event and I agree to be bound by it.

Our priority is to get people under the water this summer!

In entering your name and date below, you understand the risks and liability outlined above.

Date *

YYYY

Your Full Name *

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