Kakiebos Funduro - 25-27 April 2019

Registration & Indemnity Form
Please Note : This page needs to be completed by each rider / lift.
Copy needs to be shown at the entry gate

Personel Details Riding Details : Mark With "X"
Name & Surname 25th Obstacle Practise
MaleFemale R70 X
Age: 26th Obstacle Time Trail
Cellphone NR: R140 X
Email Address: 27th Funduro
Emergancy Contact Name :
1 Kids Loop - R150 X
Emergancy Contact NR: 2
Main Loop - R200
Banking details on request.
Quad Loop - R200
All above entry fee incl
entry to the Winter Festival
Event Organisers:
Denzil : 082 922 0858
Ferdi : 0726675607
(Full name & surname) (Parent / guardian name & surname if rider is a minor)
Will willingly be participating in the KAKIEBOS FUNDURO/Winter Festival
I acknowledge that in participating in these activities I shall be subjecting myself, family, passengers
and my quad bike / 2 wheeler to danger and the possibility of personal injury , loss of support and or
the loss of my life or family or passengers lives and / or the loss or damage to personal possessions
during this event .

Therefore , I do hereby acknowledge that I have freely and voluntarily and fully accept the risk to
myself and my minor dependents and do hereby on behalf of myself absolve the organisers of the
KAKIEBOS FUNDURO / Winter Festival , their committee , land owners and any other person involved in the
organisation of this event even where such activities constitute a negligent act or omission on the
part of the KAKIEBOS FUNDURO/Winter Festival from any claim or claims whatever the nature prior to and including
the day of the event and particularly as a result of any activity which the KAKIEBOS FUNDURO/Winter Festival is in
anyway party to .

I acknowledge the KAKIEBOS FUNDURO/Winter festival event and I do further indemnify the KAKIEBOS FUNDURO/Winter festival
against any claim or claims , which may be brought against them by any other person
arising out of my actions aforementioned , and in particular against claims made against the
KAKIEBOS FUNDURO/Winter festival for any claim or claims preferred against them by my dependents .

I Accept I Accept as the parent / guardian
(Signature) (Parent / guardian signature)