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Waiver of Liability for ‘Swim with Wild Dolphins’

This waiver applies to ‘Swim with Wild Dolphins’ the name of the tour operated by Rockingham Wild Encounters Pty Ltd and owned by Rockingham Dolphins (WA) Pty Ltd and/ or any other tours, charters or cruises conducted onboard the company vessel known as ‘Apollo 3’.

Acknowledgement and Assumption of Risk

Warning: This may affect your legal rights and obligations. If you have any questions please ask your representative before signing. Like any marine based activity, tour or cruise, passengers participating in ‘Swim with Wild Dolphins’ can be exposed to certain inherit risk, therefore: 

I acknowledge and understand that whilst participating in the activity:-

  • The conditions in which the activity is conducted may vary without warning.
  • I assume the risk of and responsibility for any injury, death or property damage resulting from my
  • participation.
  • I have listened to and understood the tour safety briefing.
  • I agree to follow all oral and written instructions given to me by Rockingham Wild Encounters Pty Ltd staff during the tour.
  • I will query any matters that I do not understand.
  • I am not under the influence of drugs/medication/mind altering substances, which affect my understanding of safety instructions, or ability to safely participate.
  • I understand that in the interest of crew and passenger safety, RWE crew will be wearing electric shark deterrents known as ‘Shark Shields’. Shark Shields website advises that ‘Direct contact with, or very close proximity to the antenna, may cause twitching of the surface muscles of the skin, in time with the slow pulsing of the signal. The conductive field readily travels through seawater, it being a better conductor than the human body. Thus the field tends to surround the body rather than penetrate it. Scientific tests show that the type of signal generated by the Shark Shield is unable to pass through body tissues, unlike radio waves or microwaves that readily penetrate the body, and therefore it poses no health problems for users. However, anyone with any health condition which could increase their sensitivity to the fields created by the Shark Shield should not use the device. Such conditions include heart disease, a history of heart attack, peripheral vascular disease, stroke, a history of fainting or epilepsy, lung disease, or if the user is on any prescription drugs that are administered for these conditions. People who have pacemakers or are pregnant must not use the Shark Shield and should also avoid swimming near any other person using the Shark Shield.
  • I will inform Rockingham Wild Encounters staff of any mental infirmity, allergies, physical disabilities, medical conditions or any other significant issues that may prejudice my performance/safety or the safety of others.

Sharing Images of the Cruise

Rockingham Wild Encounters will be capturing images of passengers and the cruise which will be made available free of charge by being uploaded to flikr.com.au

I acknowledge and understand that:

  • Any images taken during the cruise may be used by Rockingham Wild Encounters for marketing and promotion of their cruises.
  • Rockingham Wild Encounters make these images available to view and share by emailing a link to passengers who subscribe to their email database. By leaving my email address on the form overleaf, I agree to join Rockingham Wild Encounters mailing list and am aware that I can unsubscribe at any time.

Release and Indemnity to Rockingham Dolphins (WA) Pty Ltd and Rockingham Wild Encounters Pty Ltd

  • In consideration of the acceptance of my payment for participating, except to the extent it is precluded by statutory law I agree to release and indemnity Rockingham Dolphins (WA) Pty Ltd and Rockingham Wild Encounters Pty Ltd.
  • I release, indemnify and hold harmless Rockingham Dolphins (WA) Pty Ltd and Rockingham Wild Encounters Pty Ltd, its servants and agents, from and against all and any actions or claims which may be made by me or on my behalf or by other parties for or in respect of or arising out of any injury, loss, damage or death caused to me or my property whether by negligence, breach of contract or in any way whatsoever.

Today's date: May 9, 2024

First Participant's Name

First Name*

Last Name*
First Participant's Date of Birth*
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
Medical History
Click to customize checkboxes *
None
Allergies
Asthma
Back injury (or history of)
Claustrophobia
Diabetes
Epilepsy
Heart Condition
History of stroke or fainting
Lung disease
Peripheral Vascular Disease
Pregnancy
Sea Sickness
Thalassophobia (fear of open water)
Other conditions not listed above (specify below)

Short description of above medical history
COVID-19: Have you recently returned from overseas travel in the last 14 days?*
No
Yes
COVID-19: Have you been in contact with a confirmed person with COVID-19 in the last 14 days?*
No
Yes
COVID-19: Do you have any of the following symptoms; Fever, cough, shortness of breath, runny nose or are feeling unwell?*
No
Yes
COVID-19 Acknowledgement: I have answered NO to ALL of the above COVID-19 questions and will contact Perth Wildlife Encounters prior to departure and/or speak to the crew on the day of tour. *
Acknowledge
Describe your snorkeling ability.*
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*
Parent or Guardian's Date of Birth*
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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