KiteAction - Registration & Indemnity Form

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Registration & Indemnity Form

REGISTRATION & INDEMNITY FORM

Please fill in this form and bring it with you to your kite lesson

NAME:
ADDRESS:
CITY:
STATE:
EMAIL:
PHONE:

Please circle your answer

What's Your Reason for Taking a Kitesurfing Lesson?

Want to Learn a New Sport? Improve Your Skills? Holiday Experience – Fun?

Which Following Sports have you had Prior Experience?

Windsurfing Surfing Water Skiing Wakeboarding Sky Diving Snowboarding

What Swimming Level are You?

Can Not Swim Confident in Enclosed Waters (Pool)

Confident in Open Waters (Lakes, Rivers Currents)

Confident in the Ocean (Surf & Currents)

List any Physical / Medical Conditions or Current Medication you are taking
that may Affect Your Safety while Kitesurfing

INDEMNITY
I partake in the sport of kitesurfing of my own free will. I have read and understood the safety kiting
guidelines supplied to me by Kiteaction and agree to undertake kiting activities with the full
understanding of the inherent dangers and risks associated with the sport. By signing this form, I
indemnify Kiteaction and its staff from any responsibility for any damage incurred to any property,
injury to any person, or any legal action arising from my use of power kites.

Signed…………………………………………………Dated……../……../…………

Parent/Guardian(if under 18)

Signed…………………………………………………Dated……../……../…………

OFFICE USE ONLY

Date:	Instructor:	Lesson Fee:
Start:	Finish:	Wind Strength:
Location:	Tide:	Wind Direction:
Kite Size	Board Size

Incidents:

Kiteaction 21 Mayes Avenue, Caloundra QLD 4551 Tel: 07 54 913 065 Fax: 07 54 919 351
International: +61 7 54 919 351 Freecall: 1800 671 450
www.kiteaction.com.au This e-mail address is being protected from spambots. You need JavaScript enabled to view it

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