White Water Lodge Waiver/Indemnity

To be completed by the pilot and each passenger landing
on the helipad at White Water Lodge.

Please print the form out and fax it to us at: (028) 341-0348

Full name of pilot/passengers:_____________________________________________________

Home address:___________________________________________________________________

Telephone no.(h):_____________________(w):_________________________

Plane registration No.:___________________________________________________

Plane type:____________________________________________________________

No of people in party:____________________________________________________

Date of arrival: ________________________time of arrival:_________________________

Intended date of departure:_______________________________________________

Waiver/Indemnity

1. I/we hereby acknowledge the inherent dangers in the activities undertaken at White Water Lodge estate and including but not limited to its facilities, use of the airstrip/helipad and any flight to and from White Water Lodge estate and that my/our participation therein is voluntary and undertaken with full appreciation of the risks involved.

2. Accordingly, I/we hereby acknowledge that neither White Water Lodge nor its proprietors, directors, servants, associates, agents or any other person connected whether directly or indirectly with White Water Lodge shall be in any way liable for any claim arising out of any cause of whatsoever nature relating to White Water Lodge including without limitation, accident or injury, loss of life, illness, infection or damage to or loss of property.

3. I hereby indemnify White Water Lodge, its proprietors, directors, servants, associates, employees, agents or any other persons connected whether directly or indirectly with White Water Lodge against all and any claims which may be made against any of them and arising from any of the causes aforesaid and undertake that no person will be brought onto the property unless and until he or she is fully aware of and accepts this indemnity in favour of the parties referred to herein.

4. This indemnity shall be effective for the duration of my/our visit.

Signed at ___________________on ___________________________________

Pilot's signature ___________________________________________________

Signature of passengers: ___________________________________________________________________

___________________________________________________________________

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