LIABILITY AND RESPONSIBILITY AGREEMENT AND RELEASE
I MR/ MRS/ MS
This agreement by and between ______________________ (the “Passenger”), and
Pelagic Charters (the “Agreement”), effective dated ______________, governs the entire
relationship between the parties, and every possible event and contingency that may arise
therein.
WHEREFORE, in consideration of the mutual promises, covenants, and conditions of the
parties, and other good and valuable consideration, the receipt and sufficiency of which is
hereby acknowledged, the parties hereby agree as follows:
Pelagic Charters agrees to provide the Passenger transportation, food, and lodging aboard
the vessel, “Pelagic”, and transportation aboard its tender and other watercraft, which
may from time to time be necessary, in the sole discretion of Pelagic Charters.
Passenger hereby represents, warrants and agrees that (i) Passenger is physically fit to
engage in ocean Surfing/Swimming/Scuba Diving/Snorkeling and other similar or related
activities (the “Activities”), (ii) that Passenger has had sufficient training and experience
to engage in the Activities at every destination(s) of Pelagic Charters contemplated
hereunder, (iii) that the destinations may present substantial natural and other hazards,
including, but not limited to, sharp coral reefs, strong currents, large surf and storm
conditions, malaria and other diseases, civil war and terrorist activity, (iv) that Passenger
fully understands the risks involved in the Activities at these locations, and (v) that
Passenger fully, voluntarily and freely assumes any and all such risks. Passenger will
use all protective gear that Passenger deems appropriate to minimize the risk of injury.
Passenger agrees not to surf or participate in any situation which Passenger believes are
beyond Passenger’s ability or which Passenger believes to be unsafe. Passenger shall
obey all orders of the Master of Pelagic Charters.
Passenger also hereby agrees that Pelagic Charters has no responsibility or liability of any
nature whatsoever with regard to any services, transport or equipment provided by
Pelagic Charters hereunder, as to their suitability, safety, quality or condition. In
particular, Passenger agrees that Pelagic Charters is not responsible for Passenger’s
safety, including, but not limited to, Passenger’s safety while engaged in the Activities.
Complete, Unconditional Release By Passenger:
Passenger hereby releases, discharges and agrees to indemnify, defend and hold harmless
Pelagic Charters and all its agents, members, affiliates, predecessors, successors,
employees, officers, independent contractors, and governors from any and all claims or
demands for death, injury, sickness, loss, damage, delay or expense, whether known or
unknown, of whatever kind whenever occurring and however and by whomever caused,
including, but not limited to, claims arising out of the negligent or other tortious conduct
of Pelagic Charters, et al.
Passenger consents to medical treatment including, but not limited to, emergency first aid
rendered by members of the Pelagic Charters’ crew which are not medical doctors which
treatment and the results thereof shall be subject to the waivers, releases and assumption
of liability set forth in this Agreement
Passenger Initials ________
The law of Indonesia governs this Agreement and any action suit or proceedings shall be
brought before the Courts of Indonesia, which shall have exclusive jurisdiction.
In the event that any provision of this Agreement shall be determined to be illegal or
unenforceable, that provision will be limited or eliminated to the minimum extent
necessary so that this Agreement shall otherwise remain in full force and effect and
enforceable. The undersigned shall be deemed to have executed this Agreement for
himself or herself and his or her heirs, executors, administrator, successors and assigns.
The undersigned confirms that the undersigned has had sufficient time to read and
understand this Agreement. This Agreement sets forth the entire agreement between the
parties and the undersigned is not relying on any oral or written statements which are not
set forth in this Agreement in signing this Agreement including, but not limited to, any
statements set forth in brochures, advertising or promotional materials.
Signature A
Today’s Date
Parent/ Guardian must sign release for children under 18 years of age
I hereby certify that I am the parent or legal guardian of the Passenger identified above.
I have thoroughly reviewed the foregoing Agreement and hereby agree to each and every
term and condition of the foregoing Agreement without reservation and agree to release,
discharge, indemnify, defend and hold Pelagic Charters and its agents, members
affiliates, predecessors, successors, employees, officers, independent contractors and
governors free and harmless from any and all claims or liabilities. As the parent or legal
guardian of the Passenger, I willingly assume any and all responsibility and/or liability
for the actions of the Passenger.
Signature B
GP:904710 v6
Today’s Date