Consent form

Consent, Assumption of Risk and Release Form

I, _____________________________, am a participant in the________________________________ tour (the “Tour”).

I am acquainted with the various risks of participating in the Tour, including, without limitation, the significant risk of personal injury or death to myself and others and the significant risk of personal property damage or destruction, and hereby assume for the above named individual all risks and consequences associated with or arising in connection with such participation. I have current and adequate insurance, including helicopter and evacuation cover.

I hereby indemnify and hold harmless CONSERVATION INTERNATIONAL FOUNDATION, DUTCH CO. TREKKING CAMBODIA and SEE CAMBODIA DIFFERENTLY, and their respective directors, officers, employees and agents, from and against any and all claims, damages, actions, liability and expenses in connection with loss of life, personal injury and/or damage to property arising out of my participation in the Tour.

I represent that I am 15 years of age or older or the parent/guardian of the participant and legally capable of binding the participant to this Consent Assumption of Risk and Release Form. I also confirm that I have adequate insurance to cover myself in the eventuality of an accident or injury that results in needing to be airlifted out of the jungle. I also confirm that I have been supplied with, and read and understand, the Code of Conduct for participating in participating in the Tour.

I HAVE CAREFULLY READ THIS CONSENT, ASSUMPTION OF RISK AND RELEASE FORM AND UNDERSTAND AND FULLY AGREE TO ITS CONTENTS.

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Signature of Participant/Parent/Guardian
(Delete those that do not apply)

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Date

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Email Address