Participant Form

This is the ARISEZA Waiver, Release of Liability, Indemnification, and Consent to Medical Attention (Must be completed digitally before participation).

General Information

First name

Last name

ID / Passport Number

Mobile Number

Choose your event

Medical Information

Are you suffering from a medical condition, illness, or injury? *

Yes

Do you have any Allergies? *

Yes

Are you Pregnant or Breastfeeding? *

Yes

If you answered yes to any question or if there is anything you would like the Arise Team to know, Please elaborate:

In Case of Emergency (ICE) Name:

ICE Phone Number:

Relation to ICE Person:

Medical Aid Name:

Medical Aid Number:

Terms and Conditions

I declare that the info I’ve provided is accurate & complete

I am aware of the challenge and dangers of participating in this weekend and am physically and mentally able to participate in this weekend.

I accept the Waiver, Release of Liability, Indemnification and ConsentView here

I hereby confirm that I have read and fully understand the content of this form and all its contentView all terms & Conditions

Date*

Your Signature*

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