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MEDICAL DECLARATION AND EMERGENCY CONTACT DETAILS

The information below is intended to ensure your safety. Please answer all questions honestly. Having a medical condition in most cases does not mean you will be excluded from the activity. Be assured that your personal details will be kept confidential and our full discretion can be guaranteed.

Personal Details

Location
Organization/School/College name
Designation
Address
City
Location
Please attach card if available

Details in case of Emergency

Your Doctor's contact details

Medical Information

Please Tick the Box, in case you underwent medical treatment in last 5 years.

Asthma or Bronchitis
Diabetis
Sea Sickness etc.
Epilepsy/Fits, Fainiting or blackouts
Are you pregnant
Allergies to foods, materials or animals
Heart Condition
Severe Headaches
Spondylitis / Back Problem
Are you receiving any medication
Allergies to any known medication
Are you suffering from any injury / Any other

For Goa Location: (Local contact details)

We would love to stay in touch with you for future events, special contests and offers, etc., and welcome you to be a part of the Aquasail community. Please do share with us your:

I certify that the information I have provided is accurate to the best of my knowledge


Disclaimer

I fully understand and accept that all activities are voluntary and undertaken at my own risk, and that I should wear an approved life jacket at all times whilst sailing and follow all safety rules. I am aware that neither Aquasail nor its instructors/staff and/or GHCPLand/or Hyatt India Consultancy Private Limited or its affiliates ("Hyatt"), as the case may be, are responsible for any loss, injury or damage that I may sustain whilst engaged in any sailing activity and waive all rights that I may have to claim compensation against Aquasail and/or GHCPL and/or Hyatt India Consultancy Private Limited or its affiliates ("Hyatt"), as the case may be or other members in respect of any loss, injury or damage incurred whilst engaged in any sailing activity howsoever arising or due to negligence or otherwise and I indemnify them against all claims

I undertake to indemnify and keep indemnified, Aquasail and/or GHCPL and/or Hyatt India Consultancy Private Limited or its affiliates ("Hyatt"), as the case be, for all loss or damage caused by me to the equipment itself or any other property belonging to Aquasail and/or GHCPL and/or Hyatt India Consultancy Private Limited or its affiliates ("Hyatt"), as the case may be, while using the equipment. I shall return the equipment in a clean state and in good order, failing which I accept responsibility for the replacement or repair of the equipment/damaged property.

I consent to be admitted to a hospital / nursing home / dispensary of Aquasail's choice in case of any emergency which requires medical attention and I undertake to pay the full medical, transportation cost and all other related costs, charges and expenses, incurred in such an eventuality.

I agree that the governing law for any and all disputes shall be governed by the Indian law and the courts in Mumbai shall have the exclusive jurisdiction excluding the courts in my home country and any other court in the world.



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