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WHY SEA NORTH TOURS
Our Commitment and Values
Beluga Whale Conservation
Beluga Whale Information
Our Team
Our Fleet
Press and Media
OUR SUBARCTIC SAFARIS
All Tours
Beluga Whale & Historic Fort Prince of Wales Tour
Zodiac Beluga Whale Watching
Floe Ice Tours
Zodiac Boat Charters
Kayaking
Paddleboarding
Sloop Cove Historic Site & Nature Walk
PLAN YOUR TRIP
How to Reserve
Preparing for Subarctic Safari
2021 Tour Times
Waiver Forms
Traveling to Churchill
Frequently Asked Questions
Churchill and Surrounding Area Map
Accommodations in Winnipeg
GALLERY
CONTACT US
RESERVE NOW
seanorth@mymts.net
WHY SEA NORTH TOURS
Our Commitment and Values
Beluga Whale Conservation
Beluga Whale Information
Our Team
Our Fleet
Press and Media
OUR SUBARCTIC SAFARIS
All Tours
Beluga Whale & Historic Fort Prince of Wales Tour
Zodiac Beluga Whale Watching
Floe Ice Tours
Zodiac Boat Charters
Kayaking
Paddleboarding
Sloop Cove Hike
PLAN YOUR TRIP
How to Reserve
Preparing for Subarctic Safari
2021 Tour Times
Waiver Forms
Traveling to Churchill
Frequently Asked Questions
Churchill and Surrounding Area Map
Accommodations in Winnipeg
GALLERY
CONTACT US
0
Items :
0
Subtotal :
$
0.00
View Cart
Check Out
RESERVE NOW
Waiver Forms
Sea North Tours Forms
Please Fill in the Information Below to Complete your Cancellation Policy agreement, Liability Waiver and Medical Form (if you are kayaking and/or paddleboarding). Please note that you must be at least 18 years old in order to sign a liability waiver. If you are not 18 years old, please ask your parent or legal guardian to complete this process.
1
LIABILITY WAIVERY FORM
2
MEDICAL FORM
LIABILITY WAIVER FORM
RELEASE OF LIABILITY, WAIVER OF CLAIMS, ASSUMPTION OF RISKS AND INDEMNITY AGREEMENT
By signing this document you will waive or give up certain legal rights, including the right to sue or claim compensation following an accident. PLEASE FILL OUT AND SIGN YOUR LIABILITY WAIVER IN ADVANCE. PLEASE NOTE THAT YOU MUST BE AT LEAST 18 YEARS OLD IN ORDER TO SIGN A LIABILITY WAIVER. IF YOU ARE NOT 18 YEARS OLD, PLEASE ASK YOUR PARENT OR LEGAL GUARDIAN TO COMPLETE THIS PROCESS. THERE IS NO NEED TO PRINT YOUR WAIVER.
ADULT INFORMATION
Name
First
Last
CHILD 1
Participants Name
First
Last
Date of Birth
Month
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Day
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1921
1920
CHILD 2
Participants Name
First
Last
Date of Birth
Month
1
2
3
4
5
6
7
8
9
10
11
12
Day
1
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2021
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2015
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2009
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1981
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1921
1920
CHILD 3
Participants Name
First
Last
Date of Birth
Month
1
2
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5
6
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8
9
10
11
12
Day
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1921
1920
CHILD 4
Participants Name
First
Last
Date of Birth
Month
1
2
3
4
5
6
7
8
9
10
11
12
Day
1
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PLEASE REVIEW THE FOLLOWING AGREEMENT AND DIGITALLY SIGN AT THE BOTTOM
RELEASE OF LIABILITY, WAIVER OF CLAIMS, ASSUMPTION OF RISKS AND INDEMNITY AGREEMENT
*
BY SIGNING THIS DOCUMENT YOU WILL WAIVE OR GIVE UP CERTAIN LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE OR CLAIM COMPENSATION FOLLOWING AN ACCIDENT
TO: SEA NORTH TOURS LTD., Her Majesty the Queen in the Right of the Province of Manitoba, Canada and its directors, officers, shareholders, partners, insurers, sellers, resellers, local operators, employees, instructors, guides, agents, representatives, independent contractors, subcontractors, suppliers, sponsors, successors and heirs, executors, administrators, and assigns (all of whom are hereinafter referred as “the Releasees”)
DEFINITION
In this Release Agreement Beluga & Fort Tour, Estuary Tour, Sloop Cove Hike, Individual, Group and or Private Charter Boats, Across River Boat Transportation and Boat Shuttles, Kayaking, Paddleboarding (hereafter “the Activities”) shall include all activities, tours, events or services provided, arranged, organized, conducted, sponsored or authorized by the Releasees and shall include, but not limited to: estuary water, still water, Hudson Bay water and “the Activities”; rental of all gear and other equipment; orientation, briefing and instructional sessions; and all travel transport to and from the town of Churchill to the Sea North Tours Ltd. docking area.
ASSUMPTION OF RISKS
For the purpose of inducing to take me on the “the Activities” that I have purchased from the “the Releasees”, I covenant, acknowledge and agree as follows:
I am 18 years of age, I am capable of freely giving or withholding my consent, and I have freely entered into this RELEASE OF LIABILITY, WAIVER OF CLAIMS, ASSUMPTION OF RISKS AND INDEMNITY AGREEMENT. I acknowledge that “the Activities” is conducted in remote areas situated on land and or on water. I am aware that “the Activities” involve significant risks inherent to and that there are significant risks inherent in “the Activities”. These risks may include, but are not limited to: (a) mechanical breakdown of the Tour boat(s); (b) becoming stranded in remote areas; (c) being subjected to rugged terrain and a very harsh climate; (d) encounters with wild or domestic animals whose behaviour in their natural environment cannot be predicted or controlled; (i) although “the Releasees” will try to ensure quality viewing of nature and wildlife, this cannot be guaranteed in any way; (e) accidents which occur during shuttle travel to and from the town area to the docking area; (f) slip and falls while getting in or out of the boats; (g) overturning of boats, kayaks and or paddle boards; (h) loss of balance; impact, collision with boats, vessels, ships or equipment; hypothermia in and out of water; changing, inclement and unpredictable weather conditions including storms, high winds, high waves and lightening; (j) negligence on the part of other participants and NEGLIGENCE ON THE PART “THE RELEASEES”, INCLUDING THE FAILURE ON THE PART OF THE RELEASEES TO SAFEGUARD ME FROM THE RISKS, DANGERS AND HAZARDS OF PARTICIPATING IN “THE ACTIVITIES”.
I AM AWARE OF THE RISKS, DANGERS AND HAZARDS ASSOCIATED WITH THE ACTIVITIES AND I FREELY ACCEPT AND FULLY ASSUME ALL SUCH RISKS, DANGERS AND HAZARDS AND THE POSSIBILITY OF PERSONAL INJURY, DEATH, PROPERTY DAMAGE OR LOSS RESULTING THEREFROM.
I acknowledge that I am solely responsible for ensuring that I arrive and depart from the starting point of the Tour at times that permit my participation in “the Activities”. I acknowledge that the “The Releasees “ has no control over air, rail or other carriers and cannot guarantee travel schedules, which may be altered or affected by various circumstances. “The Releasees” will not be liable for any change of schedule for “the Activities” (including due to weather at the location of “the Activities”) or for any delayed or missed Tour due to cancelled or delayed journey travel to Churchill.
I agree to follow all the rules, guidelines, policies, regulations and recommendations made by “The Releasees “ and to indemnify “The Releasees” for any costs or losses suffered by it which are caused by or arise in connection with my failure to follow any such Rules of which I have been made aware by “The Releasees “, whether verbally or in writing.
RELEASE OF LIABILITY, WAIVER OF CLAIMS AND INDEMNITY AGREEMENT
In consideration of “The Releasees” agreeing to my participation in the Activities and permitting my use of their services, equipment and other facilities, and for other good and valuable consideration, the receipt and sufficiency of which is acknowledged, I hereby agree as follows:
(1). TO WAIVE ANY AND ALL CLAIMS that I have or may in the future have against “the releasees” and to release “the releasees” from any and all liability for any loss, damage, expense or injury, including death, that I may suffer or that my next of kin may suffer, as a result of my participation in the Activities, DUE TO ANY CAUSE WHATSOEVER, INCLUDING NEGLIGENCE, BREACH OF CONTRACT, OR BREACH OF ANY STATUTORY OR OTHER DUTY OF CARE, INCLUDING ANY DUTY OF CARE OWED UNDER THE OCCUPIERS LIABILITY ACT, ON THE PART OF THE RELEASEES, AND FURTHER INCLUDING THE FAILURE ON THE PART OF THE RELEASEES TO SAFEGUARD OR PROTECT ME FROM THE RISKS, DANGERS AND HAZARDS OF PARTICIPATING IN “THE ACTIVITIES” REFERRED TO ABOVE;
(2). TO HOLD HARMLESS AND INDEMNIFY “THE RELEASEES” for any and all liability for any property damage, loss or personal injury to any third party resulting from my participation in the Activities; (3). This Release Agreement shall be effective and binding upon my heirs, next of kin, executors, administrators, assigns and representatives, in the event of my death or incapacity; (4). This Release Agreement and any rights, duties and obligations as between the parties to this Release Agreement shall be governed by and interpreted solely in accordance with the laws of the province of Manitoba and the federal laws of Canada where the Activities take place and no other jurisdiction; and (5). Any litigation involving the parties to this Release Agreement shall be brought solely within the province where the Activities take place and shall be within the exclusive jurisdiction of the Courts of that province.
In entering into this Release Agreement I am not relying on any oral or written representations or statements made by “The Releasees” with respect to the safety of participating in “The Activities”, other than what is set forth in this Release Agreement.
I agree to the terms of the above agreement. I CONFIRM THAT I HAVE READ AND UNDERSTOOD THIS RELEASE AGREEMENT AND I AM AWARE THAT I AM WAIVING CERTAIN LEGAL RIGHTS WHICH I OR MY HEIRS, NEXT OF KIN, EXECUTORS, ADMINISTRATORS, ASSIGNS AND REPRESENTATIVES MAY HAVE AGAINST THE RELEASEES
I certify that I am the parent or legal guardian of the above minor(s).
Traveller 2
First
Last
RELEASE OF LIABILITY, WAIVER OF CLAIMS, ASSUMPTION OF RISKS AND INDEMNITY AGREEMENT
*
BY SIGNING THIS DOCUMENT YOU WILL WAIVE OR GIVE UP CERTAIN LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE OR CLAIM COMPENSATION FOLLOWING AN ACCIDENT
TO: SEA NORTH TOURS LTD., Her Majesty the Queen in the Right of the Province of Manitoba, Canada and its directors, officers, shareholders, partners, insurers, sellers, resellers, local operators, employees, instructors, guides, agents, representatives, independent contractors, subcontractors, suppliers, sponsors, successors and heirs, executors, administrators, and assigns (all of whom are hereinafter referred as “the Releasees”)
DEFINITION
In this Release Agreement Beluga & Fort Tour, Estuary Tour, Sloop Cove Hike, Individual, Group and or Private Charter Boats, Across River Boat Transportation and Boat Shuttles, Kayaking, Paddleboarding (hereafter “the Activities”) shall include all activities, tours, events or services provided, arranged, organized, conducted, sponsored or authorized by the Releasees and shall include, but not limited to: estuary water, still water, Hudson Bay water and “the Activities”; rental of all gear and other equipment; orientation, briefing and instructional sessions; and all travel transport to and from the town of Churchill to the Sea North Tours Ltd. docking area.
ASSUMPTION OF RISKS
For the purpose of inducing to take me on the “the Activities” that I have purchased from the “the Releasees”, I covenant, acknowledge and agree as follows:
I am 18 years of age, I am capable of freely giving or withholding my consent, and I have freely entered into this RELEASE OF LIABILITY, WAIVER OF CLAIMS, ASSUMPTION OF RISKS AND INDEMNITY AGREEMENT. I acknowledge that “the Activities” is conducted in remote areas situated on land and or on water. I am aware that “the Activities” involve significant risks inherent to and that there are significant risks inherent in “the Activities”. These risks may include, but are not limited to: (a) mechanical breakdown of the Tour boat(s); (b) becoming stranded in remote areas; (c) being subjected to rugged terrain and a very harsh climate; (d) encounters with wild or domestic animals whose behaviour in their natural environment cannot be predicted or controlled; (i) although “the Releasees” will try to ensure quality viewing of nature and wildlife, this cannot be guaranteed in any way; (e) accidents which occur during shuttle travel to and from the town area to the docking area; (f) slip and falls while getting in or out of the boats; (g) overturning of boats, kayaks and or paddle boards; (h) loss of balance; impact, collision with boats, vessels, ships or equipment; hypothermia in and out of water; changing, inclement and unpredictable weather conditions including storms, high winds, high waves and lightening; (j) negligence on the part of other participants and NEGLIGENCE ON THE PART “THE RELEASEES”, INCLUDING THE FAILURE ON THE PART OF THE RELEASEES TO SAFEGUARD ME FROM THE RISKS, DANGERS AND HAZARDS OF PARTICIPATING IN “THE ACTIVITIES”.
I AM AWARE OF THE RISKS, DANGERS AND HAZARDS ASSOCIATED WITH THE ACTIVITIES AND I FREELY ACCEPT AND FULLY ASSUME ALL SUCH RISKS, DANGERS AND HAZARDS AND THE POSSIBILITY OF PERSONAL INJURY, DEATH, PROPERTY DAMAGE OR LOSS RESULTING THEREFROM.
I acknowledge that I am solely responsible for ensuring that I arrive and depart from the starting point of the Tour at times that permit my participation in “the Activities”. I acknowledge that the “The Releasees “ has no control over air, rail or other carriers and cannot guarantee travel schedules, which may be altered or affected by various circumstances. “The Releasees” will not be liable for any change of schedule for “the Activities” (including due to weather at the location of “the Activities”) or for any delayed or missed Tour due to cancelled or delayed journey travel to Churchill.
I agree to follow all the rules, guidelines, policies, regulations and recommendations made by “The Releasees “ and to indemnify “The Releasees” for any costs or losses suffered by it which are caused by or arise in connection with my failure to follow any such Rules of which I have been made aware by “The Releasees “, whether verbally or in writing.
RELEASE OF LIABILITY, WAIVER OF CLAIMS AND INDEMNITY AGREEMENT
In consideration of “The Releasees” agreeing to my participation in the Activities and permitting my use of their services, equipment and other facilities, and for other good and valuable consideration, the receipt and sufficiency of which is acknowledged, I hereby agree as follows:
(1). TO WAIVE ANY AND ALL CLAIMS that I have or may in the future have against “the releasees” and to release “the releasees” from any and all liability for any loss, damage, expense or injury, including death, that I may suffer or that my next of kin may suffer, as a result of my participation in the Activities, DUE TO ANY CAUSE WHATSOEVER, INCLUDING NEGLIGENCE, BREACH OF CONTRACT, OR BREACH OF ANY STATUTORY OR OTHER DUTY OF CARE, INCLUDING ANY DUTY OF CARE OWED UNDER THE OCCUPIERS LIABILITY ACT, ON THE PART OF THE RELEASEES, AND FURTHER INCLUDING THE FAILURE ON THE PART OF THE RELEASEES TO SAFEGUARD OR PROTECT ME FROM THE RISKS, DANGERS AND HAZARDS OF PARTICIPATING IN “THE ACTIVITIES” REFERRED TO ABOVE;
(2). TO HOLD HARMLESS AND INDEMNIFY “THE RELEASEES” for any and all liability for any property damage, loss or personal injury to any third party resulting from my participation in the Activities; (3). This Release Agreement shall be effective and binding upon my heirs, next of kin, executors, administrators, assigns and representatives, in the event of my death or incapacity; (4). This Release Agreement and any rights, duties and obligations as between the parties to this Release Agreement shall be governed by and interpreted solely in accordance with the laws of the province of Manitoba and the federal laws of Canada where the Activities take place and no other jurisdiction; and (5). Any litigation involving the parties to this Release Agreement shall be brought solely within the province where the Activities take place and shall be within the exclusive jurisdiction of the Courts of that province.
In entering into this Release Agreement I am not relying on any oral or written representations or statements made by “The Releasees” with respect to the safety of participating in “The Activities”, other than what is set forth in this Release Agreement.
I agree to the terms of the above agreement. I CONFIRM THAT I HAVE READ AND UNDERSTOOD THIS RELEASE AGREEMENT AND I AM AWARE THAT I AM WAIVING CERTAIN LEGAL RIGHTS WHICH I OR MY HEIRS, NEXT OF KIN, EXECUTORS, ADMINISTRATORS, ASSIGNS AND REPRESENTATIVES MAY HAVE AGAINST THE RELEASEES
Traveller 3
First
Last
RELEASE OF LIABILITY, WAIVER OF CLAIMS, ASSUMPTION OF RISKS AND INDEMNITY AGREEMENT
BY SIGNING THIS DOCUMENT YOU WILL WAIVE OR GIVE UP CERTAIN LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE OR CLAIM COMPENSATION FOLLOWING AN ACCIDENT
TO: SEA NORTH TOURS LTD., Her Majesty the Queen in the Right of the Province of Manitoba, Canada and its directors, officers, shareholders, partners, insurers, sellers, resellers, local operators, employees, instructors, guides, agents, representatives, independent contractors, subcontractors, suppliers, sponsors, successors and heirs, executors, administrators, and assigns (all of whom are hereinafter referred as “the Releasees”)
DEFINITION
In this Release Agreement Beluga & Fort Tour, Estuary Tour, Sloop Cove Hike, Individual, Group and or Private Charter Boats, Across River Boat Transportation and Boat Shuttles, Kayaking, Paddleboarding (hereafter “the Activities”) shall include all activities, tours, events or services provided, arranged, organized, conducted, sponsored or authorized by the Releasees and shall include, but not limited to: estuary water, still water, Hudson Bay water and “the Activities”; rental of all gear and other equipment; orientation, briefing and instructional sessions; and all travel transport to and from the town of Churchill to the Sea North Tours Ltd. docking area.
ASSUMPTION OF RISKS
For the purpose of inducing to take me on the “the Activities” that I have purchased from the “the Releasees”, I covenant, acknowledge and agree as follows:
I am 18 years of age, I am capable of freely giving or withholding my consent, and I have freely entered into this RELEASE OF LIABILITY, WAIVER OF CLAIMS, ASSUMPTION OF RISKS AND INDEMNITY AGREEMENT. I acknowledge that “the Activities” is conducted in remote areas situated on land and or on water. I am aware that “the Activities” involve significant risks inherent to and that there are significant risks inherent in “the Activities”. These risks may include, but are not limited to: (a) mechanical breakdown of the Tour boat(s); (b) becoming stranded in remote areas; (c) being subjected to rugged terrain and a very harsh climate; (d) encounters with wild or domestic animals whose behaviour in their natural environment cannot be predicted or controlled; (i) although “the Releasees” will try to ensure quality viewing of nature and wildlife, this cannot be guaranteed in any way; (e) accidents which occur during shuttle travel to and from the town area to the docking area; (f) slip and falls while getting in or out of the boats; (g) overturning of boats, kayaks and or paddle boards; (h) loss of balance; impact, collision with boats, vessels, ships or equipment; hypothermia in and out of water; changing, inclement and unpredictable weather conditions including storms, high winds, high waves and lightening; (j) negligence on the part of other participants and NEGLIGENCE ON THE PART “THE RELEASEES”, INCLUDING THE FAILURE ON THE PART OF THE RELEASEES TO SAFEGUARD ME FROM THE RISKS, DANGERS AND HAZARDS OF PARTICIPATING IN “THE ACTIVITIES”.
I AM AWARE OF THE RISKS, DANGERS AND HAZARDS ASSOCIATED WITH THE ACTIVITIES AND I FREELY ACCEPT AND FULLY ASSUME ALL SUCH RISKS, DANGERS AND HAZARDS AND THE POSSIBILITY OF PERSONAL INJURY, DEATH, PROPERTY DAMAGE OR LOSS RESULTING THEREFROM.
I acknowledge that I am solely responsible for ensuring that I arrive and depart from the starting point of the Tour at times that permit my participation in “the Activities”. I acknowledge that the “The Releasees “ has no control over air, rail or other carriers and cannot guarantee travel schedules, which may be altered or affected by various circumstances. “The Releasees” will not be liable for any change of schedule for “the Activities” (including due to weather at the location of “the Activities”) or for any delayed or missed Tour due to cancelled or delayed journey travel to Churchill.
I agree to follow all the rules, guidelines, policies, regulations and recommendations made by “The Releasees “ and to indemnify “The Releasees” for any costs or losses suffered by it which are caused by or arise in connection with my failure to follow any such Rules of which I have been made aware by “The Releasees “, whether verbally or in writing.
RELEASE OF LIABILITY, WAIVER OF CLAIMS AND INDEMNITY AGREEMENT
In consideration of “The Releasees” agreeing to my participation in the Activities and permitting my use of their services, equipment and other facilities, and for other good and valuable consideration, the receipt and sufficiency of which is acknowledged, I hereby agree as follows:
(1). TO WAIVE ANY AND ALL CLAIMS that I have or may in the future have against “the releasees” and to release “the releasees” from any and all liability for any loss, damage, expense or injury, including death, that I may suffer or that my next of kin may suffer, as a result of my participation in the Activities, DUE TO ANY CAUSE WHATSOEVER, INCLUDING NEGLIGENCE, BREACH OF CONTRACT, OR BREACH OF ANY STATUTORY OR OTHER DUTY OF CARE, INCLUDING ANY DUTY OF CARE OWED UNDER THE OCCUPIERS LIABILITY ACT, ON THE PART OF THE RELEASEES, AND FURTHER INCLUDING THE FAILURE ON THE PART OF THE RELEASEES TO SAFEGUARD OR PROTECT ME FROM THE RISKS, DANGERS AND HAZARDS OF PARTICIPATING IN “THE ACTIVITIES” REFERRED TO ABOVE;
(2). TO HOLD HARMLESS AND INDEMNIFY “THE RELEASEES” for any and all liability for any property damage, loss or personal injury to any third party resulting from my participation in the Activities; (3). This Release Agreement shall be effective and binding upon my heirs, next of kin, executors, administrators, assigns and representatives, in the event of my death or incapacity; (4). This Release Agreement and any rights, duties and obligations as between the parties to this Release Agreement shall be governed by and interpreted solely in accordance with the laws of the province of Manitoba and the federal laws of Canada where the Activities take place and no other jurisdiction; and (5). Any litigation involving the parties to this Release Agreement shall be brought solely within the province where the Activities take place and shall be within the exclusive jurisdiction of the Courts of that province.
In entering into this Release Agreement I am not relying on any oral or written representations or statements made by “The Releasees” with respect to the safety of participating in “The Activities”, other than what is set forth in this Release Agreement.
I agree to the terms of the above agreement. I CONFIRM THAT I HAVE READ AND UNDERSTOOD THIS RELEASE AGREEMENT AND I AM AWARE THAT I AM WAIVING CERTAIN LEGAL RIGHTS WHICH I OR MY HEIRS, NEXT OF KIN, EXECUTORS, ADMINISTRATORS, ASSIGNS AND REPRESENTATIVES MAY HAVE AGAINST THE RELEASEES
MEDICAL FORM
Which of the following tours have your purchased?
Kayak and/or Paddleboard Tour
Other
REQUIRED FOR ALL PARTICIPANTS THAT HAVE PURCHASED A KAYAK AND/OR PADDLEBOARD TOUR, 12 YEARS AND UP
Participants Name
*
First
Last
Date of Birth
*
Month
1
2
3
4
5
6
7
8
9
10
11
12
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Weight
Height
Medical insurance plan
yes
no
Please list name your carrier
Physical condition
(Required physical ability to lift oneself out of the water for Paddleboard tour)
Allergies, life threatening:
Allergies, non life threatening:
Are you on any medications (prescription or non-prescription)?
no
yes
If yes, please specify:
Have you been under a doctor’s care in the past 12 months?
no
yes
If yes, please specify:
Do you have a chronic disability or illness:
no
yes
If yes, please specify:
Do you have a history of any of these ailments:
Epilepsy
Diabetes
Susceptibility to colds
Headaches
Nosebleeds
Fainting
Asthma
Hay Fever
Emphysema
or others
no
If other, please specify:
Do you have a history of joint injury?
Tendonitis
Bursitis
Sprain
Dislocation
or other
no
If other, please specify:
Eyesight:
Excellent
Good
Fair
Poor
Glasses
Contacts
Do you have any physical limitations?
no
yes
If yes, please specify:
Do you feel that you have any psychological limitations? (i.e.. fear of water, fear of heights, etc.).
no
yes
If yes, please explain:
Date
Date Format: MM slash DD slash YYYY
Digital Signature:
The above medical information is complete and accurate. If any of the information changes, I will inform the Sea North Tours Office so that the changes can be recorded. I am in good physical condition to participate. I have read the Release of Liability, Waiver of Claims, Assumption of Risks and Indemnity Agreement and agree to be bound by its terms and conditions. I agree to adhere to the rules and regulations set up by the Guides of Sea North Tours Ltd. to minimize risk and ensure safety.
Parent/Guardian Certification:
I certify that I am the parent or legal guardian of the above minor.
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