Participants Full Name and Surname (required)
Participants Email (required)
Participants ID/Passport Number
Country of Origin ---ZA - South AfricaAD - AndorraAE - United Arab EmiratesAF - AfghanistanAG - Antigua and BarbudaAI - AnguillaAL - AlbaniaAM - ArmeniaAO - AngolaAQ - AntarcticaAR - ArgentinaAS - American SamoaAT - AustriaAU - AustraliaAW - ArubaAZ - AzerbaijanBA - Bosnia and HerzegovinaBB - BarbadosBD - BangladeshBE - BelgiumBF - Burkina FasoBG - BulgariaBH - BahrainBI - BurundiBJ - BeninBL - Saint BarthelemyBM - BermudaBN - BruneiBO - BoliviaBR - BrazilBS - Bahamas, TheBT - BhutanBV - Bouvet IslandBW - BotswanaBY - BelarusBZ - BelizeCA - CanadaCC - Cocos (Keeling) IslandsCD - Congo, Democratic Republic of theCF - Central African RepublicCG - Congo, Republic of theCH - SwitzerlandCI - Cote d'IvoireCK - Cook IslandsCL - ChileCM - CameroonCN - ChinaCO - ColombiaCR - Costa RicaCU - CubaCV - Cape VerdeCW - CuracaoCX - Christmas IslandCY - CyprusCZ - Czech RepublicDE - GermanyDJ - DjiboutiDK - DenmarkDM - DominicaDO - Dominican RepublicDZ - AlgeriaEC - EcuadorEE - EstoniaEG - EgyptEH - Western SaharaER - EritreaES - SpainET - EthiopiaFI - FinlandFJ - FijiFK - Falkland Islands (Islas Malvinas)FM - Micronesia, Federated States ofFO - Faroe IslandsFR - FranceFX - France, MetropolitanGA - GabonGB - United KingdomGD - GrenadaGE - GeorgiaGF - French GuianaGG - GuernseyGH - GhanaGI - GibraltarGL - GreenlandGM - Gambia, TheGN - GuineaGP - GuadeloupeGQ - Equatorial GuineaGR - GreeceGS - South Georgia and the IslandsGT - GuatemalaGU - GuamGW - Guinea-BissauGY - GuyanaHK - Hong KongHM - Heard Island and McDonald IslandsHN - HondurasHR - CroatiaHT - HaitiHU - HungaryID - IndonesiaIE - IrelandIL - IsraelIM - Isle of ManIN - IndiaIO - British Indian Ocean TerritoryIQ - IraqIR - IranIS - IcelandIT - ItalyJE - JerseyJM - JamaicaJO - JordanJP - JapanKE - KenyaKG - KyrgyzstanKH - CambodiaKI - KiribatiKM - ComorosKN - Saint Kitts and NevisKP - Korea, NorthKR - Korea, SouthKW - KuwaitKY - Cayman IslandsKZ - KazakhstanLA - LaosLB - LebanonLC - Saint LuciaLI - LiechtensteinLK - Sri LankaLR - LiberiaLS - LesothoLT - LithuaniaLU - LuxembourgLV - LatviaLY - LibyaMA - MoroccoMC - MonacoMD - MoldovaME - MontenegroMF - Saint MartinMG - MadagascarMH - Marshall IslandsMK - MacedoniaML - MaliMM - BurmaMN - MongoliaMO - MacauMP - Northern Mariana IslandsMQ - MartiniqueMR - MauritaniaMS - MontserratMT - MaltaMU - MauritiusMV - MaldivesMW - MalawiMX - MexicoMY - MalaysiaMZ - MozambiqueNA - NamibiaNC - New CaledoniaNE - NigerNF - Norfolk IslandNG - NigeriaNI - NicaraguaNL - NetherlandsNO - NorwayNP - NepalNR - NauruNU - NiueNZ - New ZealandOM - OmanPA - PanamaPE - PeruPF - French PolynesiaPG - Papua New GuineaPH - PhilippinesPK - PakistanPL - PolandPM - Saint Pierre and MiquelonPN - Pitcairn IslandsPR - Puerto RicoPS - Gaza StripPS - West BankPT - PortugalPW - PalauPY - ParaguayQA - QatarRE - ReunionRO - RomaniaRS - SerbiaRU - RussiaRW - RwandaSA - Saudi ArabiaSB - Solomon IslandsSC - SeychellesSD - SudanSE - SwedenSG - SingaporeSH - Saint Helena, Ascension, and Tristan da CunhaSI - SloveniaSJ - SvalbardSK - SlovakiaSL - Sierra LeoneSM - San MarinoSN - SenegalSO - SomaliaSR - SurinameSS - South SudanST - Sao Tome and PrincipeSV - El SalvadorSX - Sint MaartenSY - SyriaSZ - SwazilandTC - Turks and Caicos IslandsTD - ChadTF - French Southern and Antarctic LandsTG - TogoTH - ThailandTJ - TajikistanTK - TokelauTL - Timor-LesteTM - TurkmenistanTN - TunisiaTO - TongaTR - TurkeyTT - Trinidad and TobagoTV - TuvaluTW - TaiwanTZ - TanzaniaUA - UkraineUG - UgandaUM - United States Minor Outlying IslandsUS - United StatesUY - UruguayUZ - UzbekistanVA - Holy See (Vatican City)VC - Saint Vincent and the GrenadinesVE - VenezuelaVG - British Virgin IslandsVI - Virgin IslandsVN - VietnamVU - VanuatuWF - Wallis and FutunaWS - SamoaXK - KosovoYE - YemenYT - MayotteZM - ZambiaZW - Zimbabwe
Do you have any medical conditions that we should be aware of?
By completing and submitting this form you are agreeing to the following:
I, the undersigned, by my signature hereto and pursuant to my participation in the excursion (being a biking or hiking tour of Cape Town and its surrounds, including wine farms at which there will be wine tasting and all and any activities relating thereto) hereby acknowledge, agree and undertake in favour of Bikes ‘n Wines and any of their respective members, agents, representatives and employees (“Bikes ‘n Wines”) that:
I am fully aware that the excursion may involve hazardous activities and I fully accept all the risks associated therewith; I have no pre existing health conditions that would make cycling or walking the prescribed route (s) of up to 30km at moderate pace dangerous to my health and I accept full responsibility for my current medical condition; I hereby release Bikes ‘n Wines from all liability and hold each and all of them harmless against all claims, damages, injuries, losses, deaths, expenses and liabilities arising out of or in any way connected with my participation in the excursion, including without limitation: any personal injury or loss of life; any loss or damage to my clothing or property, whether arising out of strict liability, statute or otherwise and whether caused by the negligence, gross negligence or recklessness on the part of the Bikes ‘n Wines, their respective members, agents, representatives, employees or any other person.
Each clause of this deed of indemnity is independent and severable from all other clauses.
Each element of the release from liability and/or indemnity in respect of each cause or activity covered by this release from liability and/or indemnity shall be separate and severable from the other elements.
This indemnity shall in all respects be governed by the laws of the Republic of South Africa, and all disputes, actions and other matters arising in connection therewith shall be determined in accordance with such laws.
Furthermore, with this indemnity form I agree that all media footage taken during the tour by any of the Bikes ‘n Wines staff members may be used for marketing and media purposes and is allowed to be published in the public domain.
I Agree to the Terms and Conditions
Please write your signature in the box below