Indemnity Form | NW-AGA Archery

AGA-SA Indemnity Form

North West Province

This form must be completed and signed by all members of AGA-SA. Minors must be supported by their parents or legal guardians.

It is the responsibility of the Provincial Coordinators to ensure that all members have signed the indemnity document and to keep the documents on record.

All archery and/or other activities involving cubs, junior and senior members are under the guidance of qualified coaches and to the appropriate rules of Africa Genesis Archery South Africa NPC (AGA-SA).

Details of Parent / Spouse / Guardian

First Name

Last Name

ID Number

Phone Number

Email Address

Physical Address

Country/Region

Address

City

Zip / Postal code

Details of Archer

Archer's Full Name/s and Surname

Archer's ID Number

Archher's Membership

Archer's Member Number / Shooter Number

Archer's Phone Number

Archer's Email

Archer's Medical Information

Emergency Contact Details (If different from above)

Name and Surname

Phone Number

Please select the option that applies to the archer

I have private medical aid

I have private healthcare cover / medical insurance

I do NOT have medical aid or private healthcare cover

Other

Medical Aid Provider

Medical Aid Number

Medical Aid Plan

Name of Main Member

Beneficiary / Dependent Code

Name of Doctor / GP

Doctor / GP Phone Number

If emergency hospitalisation is required, please select where the archer should be transported

Private Hospital

Public / Government Hospital

Does the archer have any medical conditions or allergies that the Coach/Usher should be aware of?

Yes

If Yes, please provide details of the condition or allergy

Please provide details of medication that must be administered for any condition or allergies

For safety, we recommend that any medication that may be required during an event be handed to the Coach / Usher for safekeeping.

Consent and Agreement by Parent / Spouse / Guaridan / Archer

(AAG archers included)

a) I agree to my/my son’s/my daughter’s participation in activities presented by AGA-SA.

b) I confirm, to the best of my knowledge, that I/my son/my daughter does not suffer from any medical condition other than those disclosed above.

c) I consent to myself/my son/my daughter travelling by public transport, minibus or motor vehicle driven by an approved driver/coach or another approved parent when travelling to or from any event in which we will be participating.

d) I understand that AGA-SA organisers and/or management do not accept responsibility for any loss, damage or injury caused by or arising during attendance at any organised activity, except where such loss, damage or injury can be shown to have resulted directly from the gross negligence of an AGA-SA organiser or official.

e) I acknowledge and understand that participation in the sport of archery involves inherent dangers and risks. These may include, but are not limited to, minor scrapes, strains and bruises, as well as more significant injuries to the musculoskeletal system, internal organs, oral or dental areas, and eyes. Such injuries may result from my own actions, the actions of others, or a combination thereof.

f) I acknowledge and understand that AGA-SA does not provide or carry accident or health insurance for participants in its sporting activities. I further understand that sports-related injuries may result in significant medical expenses, particularly where the participant does not have medical cover.

g) As an archer, I agree to stop participating immediately if I experience discomfort, disorientation, a lack of well-being, or any medical condition or symptoms that may affect my safe participation in the sport.

h) As an archer, I acknowledge the potential risk of injury associated with participation in the sport and agree to comply with all applicable safety rules, regulations and procedures at all times.

i) I, the undersigned, agree to indemnify and hold AGA-SA and its officials, agents and employees harmless from any damages, liabilities, claims, legal costs and other costs arising from participation in the sport or the use of any facilities, subject to applicable law.

j) I understand that this indemnity also applies to losses or damages resulting from the acts or omissions of any guest, participant, visitor or other person attending an AGA-SA event, subject to applicable law.

I hereby acknowledge all risks associated with my participation in sporting activities presented by AGA-SA and, on behalf of myself, my heirs, executors, administrators and assigns, agree to release, waive, discharge, relinquish, indemnify and hold harmless Africa Genesis Archery South Africa NPC (AGA-SA), the Board of Governors, the Board of Trustees, and their respective officers, employees and agents from any and all obligations, liabilities, claims, demands, costs and expenses (including legal fees) whatsoever that may arise from or in connection with my participation in AGA-SA activities.

In signing this agreement, I confirm that I have carefully read and understood its terms and acknowledge that they constitute a release and assumption of risk. I confirm that I am at least 18 years of age, fully competent, and that I enter into this agreement voluntarily.

By checking this box and submitting this form, I confirm my consent and acknowledge that my electronic submission constitutes my signature and acceptance of this declaration.

Date

AGA-SA respects your right to privacy and aims to ensure compliance with the Protection of Personal Information Act 4 of 2013 (POPIA), which regulates the manner in which personal information is collected, processed, stored, shared and destroyed. AGA-SA is committed to protecting any personal information provided to us and to processing such information lawfully and responsibly.