WAIVER OF LIABILITY
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Responsibility & Release of Liability
Chiawa Camp and/or Old Mondoro and/or Puku Ridge and/or Chichele Lodge are located in a dynamic, remote, African wilderness environment populated with wild animals. Guests must understand and accept there are hazards associated with travelling, visiting and participating on safari in such an environment. Travel schedules to and from Zambia can change due to adverse weather, strikes, or other factors beyond our control. This can cause delay and even missed international connections. Such delays could impose additional cost to you in hotels or in changing airline tickets for which we cannot be responsible. 
Voluntary Participation
I acknowledge that I have voluntarily applied to visit and participate in the activities at Chiawa Camp and/or Old Mondoro and/or Puku Ridge and/or Chichele Lodge. I am voluntarily travelling to and / or from, visiting and participating in the activities at Chiawa Camp and/or Old Mondoro and/or Puku Ridge and/or Chichele Lodge with knowledge that the travel, accommodation and activities associated with Chiawa Camp and/or Old Mondoro and/or Puku Ridge and/or Chichele Lodge are potentially hazardous with risk of loss, damage, delay illness, injury or death which may be caused by forces of nature, the negligence of Chiawa Camp and/or Old Mondoro and/or Puku Ridge and/or Chichele Lodge, their affiliated agencies, their employees, or other agencies known or unknown. I am also aware that medical services or facilities may not be readily available or accessible during some or all of the time while I am at Chiawa Camp and/or Old Mondoro and/or Puku Ridge and/or Chichele Lodge. 

In order to visit and participate in the activities associated with Chiawa Camp and/or Old Mondoro and/or Puku Ridge and/or Chichele Lodge, I am willing to accept the risks and uncertainty involved as being an integral part of my experience at Chiawa Camp and/or Old Mondoro and/or Puku Ridge and/or Chichele Lodge. I hereby accept and assume full responsibility for any and all risks of loss, damage, delay, illness, injury, or death due to the negligence (but not the reckless, willful, or fraudulent conduct) of Chiawa Camp and/or Old Mondoro and/or Puku Ridge and/or Chichele Lodge, G&G Safaris Ltd and/or Chakwenga Safaris Litd and/or Chichele Safaris Ltd, their Directors, Shareholders, Officers, affiliated agencies, their employees, or other agencies known or unknown. 
Indemnity
As consideration for being permitted to visit and participate in the activities associated with Chiawa Camp and/or Old Mondoro and/or Puku Ridge and/or Chichele Lodge, I hereby agree that neither I, nor any of my heirs, personal or legal representatives, or family members will bring suit or make a claim for illness, injury or death resulting from the negligence (but not reckless, willful, or fraudulent conduct) of Chiawa Camp and/or Old Mondoro and/or Puku Ridge and/or Chichele Lodge, G&G Safaris Ltd and/or Chakwenga Safaris Litd and/or Chichele Safaris Ltd., their Directors, Shareholders, Officers, affiliated agencies, their employees, and the supplier of the hospitality, facilities and equipment I will use during my visit to Chiawa Camp and/or Old Mondoro and/or Puku Ridge and/or Chichele Lodge. I hereby indemnify and release Chiawa Camp and/or Old Mondoro and/or Puku Ridge and/or Chichele Lodge, G&G Safaris Ltd and/or Chakwenga Safaris Ltd and/or Chichele Safaris Ltd, their Directors, Shareholders, Officers, affiliated agencies, their employees, and the supplier of the hospitality, facilities and equipment I will use during my visit to Chiawa Camp and/or Old Mondoro and/or Puku Ridge and/or Chichele Lodge from and against any and all liability arising out of, or in any way connected with, my visit to Chiawa Camp and/or Old Mondoro and/or Puku Ridge and/or Chichele Lodge, including any liability for negligence (but not reckless, willful, or fraudulent conduct).
Controlling Law
Any controversy or claim arising out of or relating to this Agreement or the performance hereunder, including without limitation any claim related to the loss, damage, illness, injury or death shall be governed by Zambian law. Any lawsuit filed as a result of my visit to Chiawa Camp and/or Old Mondoro and/or Puku Ridge and/or Chichele Lodge shall be filed in the High Court in Lusaka, Zambia.
Knowing and Voluntary Execution
I have carefully read this agreement and understand its contents. I am aware that this is a release of liability and that paying in part or in full for a visit to Chiawa Camp and/or Old Mondoro and/or Puku Ridge and/or Chichele Lodge and / or traveling to and / or from and / or visiting Chiawa Camp and/or Old Mondoro and/or Puku Ridge and/or Chichele Lodge is acknowledgement that I have read and accept the cancellation/refund and responsibility clauses. 

To be signed by each adult in the party. Parents must list and sign for all minors in the party.
CORONAVIRUS EXCLUSION
The Company will not indemnify any client for any loss following any contraction of the following

a) Coronavirus disease (COVID-19);

b) Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2);

c) any mutation or variation of SARS-CoV-2;

d) any fear or threat of a), b) or c) above.
[ GUEST ONE ] FULL NAME - PASSPORT NUMBER - NATIONALITY - EXPIRY *
[ GUEST TWO ] FULL NAME - PASSPORT NUMBER - NATIONALITY - EXPIRY
[ GUEST THREE ] FULL NAME - PASSPORT NUMBER - NATIONALITY - EXPIRY
[ GUEST FOUR ] FULL NAME - PASSPORT NUMBER - NATIONALITY - EXPIRY
[ GUEST FIVE ] FULL NAME - PASSPORT NUMBER - NATIONALITY - EXPIRY
[ GUEST SIX ] FULL NAME - PASSPORT NUMBER - NATIONALITY - EXPIRY
CHECK THE BOX BELOW TO INDICATE YOUR SIGNATURE AND ACCEPTANCE OF THE ABOVE LIABILITY POLICY. *
I am aware that this is a release of liability and that paying in part or in full for a visit to Chiawa Camp and/or Old Mondoro and/or Puku Ridge and/or Chichele Lodge and / or traveling to and / or from and / or visiting Chiawa Camp and/or Old Mondoro and/or Puku Ridge and/or Chichele Lodge is acknowledgement that I have read and accept the cancellation/refund and responsibility clauses. 
Required
PLEASE SELECT TODAY'S DATE *
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FIRST & LAST NAME OF MAIN BOOKING GUEST *
EMERGENCY CONTACT NAME & PHONE NUMBER & ADDRESS *
MEDICAL INSURANCE CARRIER & MEMBER NUMBER *
PLEASE LIST ANY KNOWN MEDICAL CONDITIONS *
DO YOU HAVE ANY MEDICAL TRAINING? *
DATE OF ARRIVAL *
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FLIGHT NUMBER & ARRIVAL TIME *
TRAVELING FROM (PREVIOUS DESTINATION ON ITINERARY) *
DATE OF DEPARTURE *
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DD
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YYYY
FLIGHT NUMBER & ARRIVAL TIME *
TRAVELING TO (NEXT DESTINATION ON ITINERARY) *
DO YOU HAVE ANY SPECIAL DIETARY REQUIREMENTS? *
ARE THERE ANY SPECIAL INTERESTS OR CELEBRATIONS DURING YOUR SAFARI THAT WE SHOULD BE AWARE OF? *
A copy of your responses will be emailed to the address you provided.
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