Step 1 of 3
Please complete the online waiver for Hop House before entering the premises.
Your intentional action in electronically signing or initialing this contract is valid evidence of your consent to be legally bound by this agreement.
You are Soley responsible for reviewing and understanding all of the terms and
conditions of all the related documentation on application of each student.
If more than one individual has electronically completed, signed and initialed
this contract and agreement, your obligations will be joint and several.
The electronically stored copy of the signed documentation will be considered
true, complete, valid, authentic and enforceable record of the clients
agreements, admissible in judicial or administrative proceedings to the same
extent as if the documents and records were originally generated and
maintained in printed form.
Please complete all the fields with as much detail as possible
Maximum number of children added reached.
Participants Agreement, Indemnification, Assumption of Risk, and Release of Liability
In consideration of the services of Country House School, together with all agents, owners, managers, successors, affiliates, sponsors, landlords, partners, investors, participants, volunteers, employees, and all other persons or entities acting in any capacity on behalf of the previously named company, collectively referred to us Country House School, I hereby agree release, indemnify, and discharge Country House School, on behalf of myself, my spouse, my children, my parents, my heirs, my wards, assigns, personal representatives and estate as follows:
Assumption and Acknowledgement of All Risks
I, the undersigned adult listed below, am at least 18 years of age. On my own behalf, and on the behalf of the below listed participants under the age of 18 (“minors”), as their parent, legal guardian or custodian, knowingly, voluntarily, and freely accept and assume any and all risks, both known and unknown, of injuries or other loss or damage that may be suffered while on Country House School premises (7 Witfontein street, Heather park), when making use of our facilities however caused, even if caused in whole or in part by the action, inaction or negligence of Country House School premises. I represent that I have full authority as parent or legal guardian of the below listed minors. I understand that risks simply cannot be eliminated without jeopardizing the essential qualities of the activity and I expressly agree and promise to accept and assume all the risk voluntarily existing in these activities. Such risks include, but are not limited to, cuts and bruises, falls, broken bones, injuries to wrist, arms, legs, ankles, backs, heads and necks injuries from flips or contact with other participants, spinal injuries and / or death, and which may occur as a result of use or misuse of the facility in any way by anyone, use of equipment that malfunctions or breaks, and / or improper maintenance of the facility, grounds or equipment. Further, I have explained these risks to the listed minors. I certify that I and / or the listed minors are in good physical condition for the activities in which I and / or they will be participating and certify that I and / or they do not have any medical condition that may preclude me and / or them from safety participating.
Waiver of All Claims
I, on my own behalf, and on the behalf of the listed minors, expressly waive any and all claims, suit or demands for personal injury, property damage or any other loss against Country House School premises, including but not limited to any and all negligence, negligent supervision and / or negligent instructions, faulty equipment, or the activities of others. To the fullest extent permitted by law, this waiver is intended to be complete release of Country House school premises for any and all responsibility for personal injuries, property damage or loss, or death sustained by me or any of the listed minors on Country House school premises, whether arising out of or resulting from my or their participation in activities, use of trampolines, play apparatus, indoor pool or other equipment, premises and facilities. This release applies forever, for any date in the future including today’s date, that I or the listed minors may visit the country house school premises, and is further binding on the heirs, representatives and estates of the undersigned and minors. I expressly and voluntarily agree to waive, release, acquit and forever discharge Country House school and agree to defend, indemnify and hold harmless Country House school from and against all claims, damages, injuries, expenses, or death arising out of or resulting from administering of or failing to administer medical assistance to me or any of the listed minors. I certify that I have adequate insurance to cover any injury or damage that I may cause or suffer while participating, or else I agree to bear the costs of such injury or damage myself. I grant Country House school premises the right to request emergency medical services for me and / or the listed minors in the Country House school premises deem a situation medically necessary and I agree to cover any and all associated expenses.
Authorization to Use Images
Country House School premises is hereby granted the right to photograph and / or video record me and / or the listed minors and allowed to use my or their name, voice and appearance in connection with social media and promotional materials. I acknowledge and agree that the rights granted to this release are without compensation of any kind. I, for myself and for the listed minors as their parent, legal guardian or legally authorized custodian, have carefully read this agreement, fully understand its terms, and sign it freely and voluntarily.
I understand that I have given up substantial rights by signing it, and agree to be bound by its terms for myself and on behalf of the listed minors. If any portion this agreement is found to be void or unenforceable by South Africa law, the remaining portion shall remain in full force and effect. Information provided will strictly not be shred to third parties for marketing or other such gain. It is solely to establish proof of consent to the terms of this waiver.