_______ Annual Permit Application ______

Main Member/ Rider or Guardian of Rider (if under 18 years)

Emergency Details

Child 1 Details

Child 2 Details

Child 3 Details

Child 4 Details

I acknowledge that by signing this document, I am assuming risks and agree to indemnify, not to sue and release from liability Christopher Grant Nixon (ID No 680927 5316 089), Meerenhof Properties (Pty) Ltd (Reg No 2013/015642/07) and its shareholders, directors, employees, agents and/ or any parties associated with them (“ the Indemnified Parties ”) and that I am giving up substantial legal rights;

Fully understand and assume the risks associated with partaking in cycling, including, by way of example and not limited to, the dangers of collision with pedestrians, vehicles, other athletes and racers, fixed or moving objects, the dangers arising from surface hazards, including potholes, equipment failure, inadequate safety equipment, the athletes own negligence, the negligence of others and weather conditions, the possibility of serious physical and/or mental trauma or injury, or death associated with cycling and competition;

For myself, my heirs, executors, administrators, legal representatives, assignees, successors in interest, hereby agree that none of the Indemnified Parties shall be liable me for any loss or damage sustained as a result of my/our death, injury or illness or for any loss or damage to any property occurring within or arising from my/our participation in any phase of the training program hosted by Christopher Grant Nixon and/or while present on the premises of Meerenhof Properties (Pty) Ltd (“ the Property ”) and/or while participating in any activities hosted on the Property, however caused, and whether allegedly due to the act or omission, negligence or otherwise of the Indemnified Parties or arising from the use of any facilities supplied or from alleged defect in any

Agree that, if and to the extent that any of the Indemnified Parties may be found liable notwithstanding the above, such liability shall be limited to an aggregate amount of R1000 in total.

This is a contract with legal and binding consequences.

I have read it carefully before signing and I understand what it means and what I am agreeing to by signing.

I Agree to the Terms & Conditions (required)
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