Indemnity Form

I do hereby warrant and acknowledge on behalf of all group/family members:

1. that our general health is good;

2. that we understand and appreciate fully the fact that the Lodge is a Nature Conservancy and that there are free roaming wild animals. There might be exposure to one or more of the potentially dangerous animals, such as warthog, antelope, poisonous snakes and scorpions, insects and plants;

3. that we are aware of the potential dangers of exposure to the sun - directly or indirectly - and that serious sunburn may result from unprotected exposure;

We voluntarily assume the risk inherent with the stay and offered activities at the Lodge. We, together with our heirs hereby release Kokkino (Pty) Ltd., trading as lketla Lodge, its owners, managers, servants and representatives, from any duty or care towards me in connection with our stay at the Lodge and from any liability from all or any claims that could accrue to me or my heirs, executors and administrators arising out of any activities in connection with my/our stay at the Lodge irrespective of whether such claim or claims arose through the negligence of any person, or from any of the risks, dangers or hazards inherent in an African Tour, or of any loss, or damage to, any property from any cause whatsoever and I further indemnify and hold harmless associated persons against any claims however the same may arise.

* Required Fileds