Example:
West Bay Nippers Indemnity and Consent Form 西子灣兒童衝浪救生 (賠償)和同意書
Season: 2024/05/04 – 2024/10/20
Block 1: 2025/05/04 – 2024/7/7
Block 2: 2025/8/25 – 2024/10/20
Location: Kaohsiung City, Xizihwan, No. 70, Lianhai Road, Gushan District (Boathouse B, Xiziwan Sea Area Center) 鼓山區蓮海路70號 (西子灣海域中心B艇庫)
Type of Activity: Surf Safety 衝浪安全
Child’s Details 孩子的詳細信息
Child’s Full English Name: 孩子的英文全名：—————–
Child’s Full Chinese Name: 孩子的中文全名：—————-
Home address: 地址：—————————————–
Phone Number: 電話號碼：———————-
Date of Birth: (year, month, date) 出生日期：（年、月、日）———————-
Parent/Guardian Details 家長/監護人詳細信息
Full English Name or Full Chinese Name: 英文全名或中文全名：——————
Home Address: 地址：———————————-
Phone Number: 電話號碼： ———————————-
Line App ID: _______________________
Emergency Contact #1 If there’s an emergency, please contact (only fill in if different from the person named above) 緊急聯繫人 #1 如有緊急情況，請聯繫（與以上姓名不同者才填寫）：
Full English Name or Full Chinese Name: 英文全名或中文全名：———————
Phone Number: 電話號碼：————————————
Line App ID: _____________________________
Emergency Contact #2 (Optional) 緊急聯繫人 #2（可選）
Full English Name or Full Chinese Name: 英文全名或中文全名：——————
Phone Number: 電話號碼：———————————
Line App ID: _____________________________
Extra Information 額外的信息
Do we need to provide any extra help, for example, because of a disability, or are there any activities that your child cannot participate in?
我們是否需要提供任何額外幫助，例如因為殘疾，或者是否有您的孩子不能參加的活動？
——————————————–
Do we need to know about any medical conditions or allergies? (If yes, please provide details of the condition(s) and any medication needed).
我們需要了解任何醫療狀況或過敏嗎？ （如果是，請提供病情的詳細信息和所需的任何藥物）。
————————————-
Is there anything else you think we should know?
您認為我們還應該知道什麼嗎？
—————————————-
Information for Parents/Guardians
The West Bay Nippers 西子灣兒童衝浪救生 Club aims to provide a safe and enjoyable experience for every child or young person. To help us do this, please note the following important information:
West Bay Nippers 西子灣兒童衝浪救生俱樂部旨在為每個兒童或青少年提供安全和愉快的體驗。 為了幫助我們做到這一點，請注意以下重要信息：
1.1 All questions on the (indemnity and consent) form must be completed and signed by the parent/guardian before any child takes part in West Bay Nippers 西子灣兒童衝浪救生 activities.
1.2 Parents/Guardians must ensure they notify us of any changes to the information given on the form.
1.3 Parents/Guardians must arrange for children to be brought to and from the activity safely and on time.
1.4 Ensure you and your child have Public Liability Insurance and the appropriate water activity insurance for the event and activity.
1.5 We cannot take responsibility for damaged clothing and/or personal items during the activity.
1.6 Parents/Guardians should ensure children have sufficient water, food, clothing, and medication (where appropriate) for the duration of the activity.
1.1 在任何孩子參加 West Bay Nippers 西部灣兒童衝浪救生活動之前，必須由家長/監護人填寫並簽署(賠償)和同意書上的所有問題。
1.2 家長/監護人必須確保他們將表格上提供的信息的任何更改通知我們。
1.3 家長/監護人必須安排孩子安全準時地往返活動。
1.4 確保您和您的孩子擁有公共責任保險和適合活動的水上活動保險。
1.5 我們不對活動期間損壞的衣物和/或個人物品負責。
1.6 家長/監護人應確保兒童在活動期間有足夠的水、食物、衣服和藥物（如適用）。
If a young athlete is keen to take part in an activity, but their parent/guardian is not ready to give consent:
如果年輕運動員熱衷於參加某項活動，但他們的父母/監護人尚未準備好表示同意：
2.1 The West Bay Nipper Club will talk to the parent/guardian to understand the reason for their objection.
2.2 Discuss whether The West Bay Nippers Club can do anything to make the activity more suitable for the young athlete (for example, by providing extra supervision/support).
2.3 Suggest other activities the young athlete could participate in which their parent/guardian may be more comfortable attending.
2.4 Support the parents/guardians in explaining to the young athlete why they are not comfortable with them taking part in the activity.
2.1 West Bay Nipper Club 將與家長/監護人交談，了解他們反對的原因。
2.2 討論 West Bay Nippers Club 是否可以採取任何措施使活動更適合年輕運動員（例如，提供額外的監督/支持）。
2.3 建議年輕運動員可以參加的其他他們的父母/監護人可能更願意參加的活動。
2.4 支持父母/監護人向年輕運動員解釋為什麼他們對他們參加活動感到不自在。
Information for Parents/Guardians 給家長/監護人的信息
I and/or my child participate in the West Bay Nippers beach and water activities (The Event). The Event means performing or participating in any activity within the specified time and authorized or recognized by the West Bay Nippers Club, its associates, its members, and their respective officers, directors, members, servants, or agents. I hereby state, acknowledge, represent, undertake and agree as below:
我和/或我的孩子參加了 West Bay Nippers 海灘和水上活動（活動）。 活動是指在指定時間內執行或參與任何活動，並得到 West Bay Nippers Club、其員工、成員及其各自的高級職員、董事、成員、僱員或代理人的授權或認可。 本人特此聲明、承認、陳述、承諾並同意如下：
3. I have read and understood all the information about the West Bay Nippers Club and The Event. I acknowledge my application will be evaluated and may be rejected or accepted. The West Bay Nippers Club and The Event policies and procedures, and rules, including the Code of Conduct, are necessary and reasonable for promoting West Bay Nippers as a free community service.
3. 我已閱讀並理解有關 West Bay Nippers Club 和 The Event 的所有信息。 我承認我的申請將被評估並可能被拒絕或接受。 West Bay Nippers Club 和 The Event 政策和程序以及規則，包括行為準則，對於將 West Bay Nippers 推廣為一項免費社區服務是必要且合理的。
4. I understand the demanding physical nature of these activities. As a condition of entry to the West Bay Nippers Club and The Event, I declare that I have sufficiently trained for these beach and water activities. I am unaware of any illness, injury, or any other physical disability which may cause me injury or death while participating in West Bay Nippers and The Event.
4. 我理解這些活動對體力的要求。 作為進入 West Bay Nippers Club 和 The Event 的條件，我聲明我已經接受了這些海灘和水上活動的充分訓練。 我不知道在參加 West Bay Nippers 和 The Event 時是否有任何疾病、受傷或任何其他身體殘疾可能導致我受傷或死亡。
5. If I become aware of any medical condition or impairment or am sick or injured before or during the activities, I will withdraw from the Event. Warning: If you suffer or have suffered from any illness or physical, emotional, mental, or psychological disability likely to influence your efficiency as a West Bay Nippers Club member or participant, it may impact your safety, a participant’s safety, and the public’s safety. You should consult your medical practitioner before commencing The Event.
5. 如果我在活動前或活動期間發現任何健康狀況或損傷、生病或受傷，我將退出活動。 警告：如果您患有或曾經患有任何可能影響您作為 West Bay Nippers Club 會員或參與者的效率的疾病或身體、情感、精神或心理殘疾，它可能會影響您的安全、參與者的安全以及公眾的安全 . 在開始活動之前，您應該諮詢您的醫生。
6. The West Bay Nippers Club activities and The Event is a physically challenging program, and participation in it presents medical risks, many of which can be extremely serious or fatal.
6. West Bay Nippers Club 活動和 The Event 是一項對身體具有挑戰性的項目，參與其中會帶來醫療風險，其中許多可能極其嚴重或致命。
7. I acknowledge that participating in the West Bay Nippers and The Event is dangerous and that I am exposed to certain risks by such participation. I acknowledge that the enjoyment of beach and water activities is derived partly from the inherent risks and exertion beyond the assumed safety of life at home or work. These risks and hazards contribute to enjoyment and pleasure and are a reason for my participation in The Event.
7. 我承認參加 West Bay Nippers 和 The Event 是危險的，我會因參加此類活動而面臨某些風險。 我承認海灘和水上活動的樂趣部分來自於固有的風險和超出假定的家庭或工作生活安全的努力。 這些風險和危險有助於享受和快樂，也是我參加 The Event 的原因。
8. I am medically, mentally, emotionally, and physically fit and can participate in any West Bay Nippers activities. I am currently not, and in the future, I must not be a danger to myself or the health and safety of others. In writing, I will immediately notify the West Bay Nippers Club and The Event of any changes to my fitness, medical condition, and ability to participate.
8. 我在醫學上、精神上、情感上和身體上都健康，可以參加任何 West Bay Nippers 活動。 我目前不是，將來也不會對自己或他人的健康和安全構成威脅。 如果我的身體狀況、健康狀況和參與能力有任何變化，我將以書面形式立即通知 West Bay Nippers Club 和 The Event。
9. Warning: West Bay Nippers and the Event can be dangerous. I accept that I am exposed to risks during The Event and activities, including but not limited to contact with surf lifesaving equipment and surf craft, body contact, physical exertion, and surf, sea, and weather conditions. I recognize that accidents can and often do happen, resulting in injury, death, or property damage. I have willingly read and understood this warning. I acknowledge and accept the risks in participating in West Bay Nippers and The Event.
警告：West Bay Nippers 和 Event 可能很危險。 我接受我在活動和活動期間面臨風險，包括但不限於接觸衝浪救生設備和衝浪艇、身體接觸、體力消耗以及沖浪、海浪和天氣狀況。 我知道事故可能而且經常發生，導致人身傷害、死亡或財產損失。 我已自願閱讀並理解此警告。 我承認並接受參與 West Bay Nippers 和 The Event 的風險。
10. I accept and understand that while participating in West Bay Nippers and The Event:
10.1 I may be hurt, physically or mentally, or may die from diverse reasons including, but not limited to, overexertion, dehydration, drowning, trips or falls, cardiac arrest, slips, accidents with other players, bystanders, or accidents provoked by my actions.
10.2 My personal property may be lost or damaged.
10.3 The circumstances and conditions in which The Event is performed may vary without warning. I may be in a hard-to-reach or isolated area where access to medical support may be limited, and it may take considerable time and effort to reach me.
10.4 There may be no or inadequate facilities for my treatment or transport if I am injured
10.5 I accept the responsibility and risk for any property damage, injury, or death resulting from my participation in West Bay Nippers and the Event.
10. 我接受並理解在參加 West Bay Nippers 和活動時：
10.1 我可能會受到身體或精神上的傷害，或者可能因各種原因而死亡，包括但不限於過度勞累、脫水、溺水、絆倒或跌倒、心臟驟停、滑倒、與其他玩家、旁觀者發生事故或由我引起的事故 動作。
10.2 我的個人財產可能丟失或損壞。
10.3 進行活動的環境和條件可能會有所不同，恕不另行通知。 我可能位於難以到達或偏遠的地區，那裡獲得醫療支持的機會可能有限，而且可能需要花費大量時間和精力才能找到我。
10.4 如果我受傷，可能沒有或沒有足夠的設施供我治療或運輸
10.5 我接受因我參加 West Bay Nippers 和活動而導致的任何財產損失、傷害或死亡的責任和風險。
11. I also acknowledge and understand that while participating in the Event:
11.1 I agree and will prepare all mandatory equipment and wear the Club Cap.
11.2 I will obey the orders of the organizer, staff, or volunteers during The Event.
11. 我也承認並理解在參加活動時：
11.1 我同意並將準備好所有強制性裝備並戴上俱樂部帽。
11.2 活動期間本人服從主辦方、工作人員或志願者的指揮。
12. I consent that if I am hurt or require medical emergency help, the Event Organizers can, at my cost, organize medical treatment and emergency evacuation as considered essential by the Event Organizers. I consent that I am accountable for my medical, health, public liability, and ambulance insurance coverage. I will bring my National Health Insurance Card to the Event.
12. 我同意，如果我受傷或需要緊急醫療幫助，活動組織者可以在活動組織者認為必要的情況下組織醫療和緊急疏散，費用由我承擔。 我同意我對我的醫療、健康、公共責任和救護車保險負責。 我將攜帶我的國民健康保險證參加活動。
13. I consent to release, indemnify and hold harmless West Bay Nippers and the Event organizers, club members, coaches, employees, agents, its officers, volunteers, public bodies, landholders, contractors, and The Event sponsors, from and against all and any claims, rights, demands, or cause of action, lawsuits, expenses, costs, and proceedings of any nature whatsoever which I may make or on my behalf or by other parties for or in regard of or emerging out of any injury, loss, damage or death caused to me or my property as a result of my entry or participation in the Event whether, breach of contract, by negligence or in any way whatsoever.
13. 我同意釋放、賠償和保護 West Bay Nippers 和活動組織者、俱樂部成員、教練、僱員、代理人、其官員、志願者、公共機構、土地所有者、承包商和活動贊助商免受所有和 任何索賠、權利、要求或訴訟因由、訴訟、費用、費用和任何性質的訴訟，我可能或代表我或由其他方針對或因任何傷害、損失或因任何傷害、損失而提出， 因我參加或參與活動而對我或我的財產造成的損害或死亡，無論是違約、疏忽或以任何方式造成的。
14. I also agree that if my property is damaged or I am injured, I will bring no claim, legal or otherwise, against the West Bay Nippers Club and The Event organizers regarding that damage or injury.
14. 我還同意，如果我的財產受損或受傷，我不會就該損害或傷害向 West Bay Nippers Club 和活動組織者提出任何法律或其他方面的索賠。
15. I consent to permit my results, name, videos, photographs, multimedia, or film likeness to be used for any fair purpose by the West Bay Nippers Club and The Event without compensation or payment. I acknowledge and agree to the Event being photographed and video recorded for legal reasons and to provide personal feedback.
15. 我同意允許 West Bay Nippers Club 和 The Event 將我的結果、姓名、視頻、照片、多媒體或電影肖像用於任何公平目的，無需補償或付款。 我承認並同意出於法律原因對活動進行拍照和錄像，並提供個人反饋。
16. I agree to abide by the Event rules and the directions of all officials. I acknowledge that important information is provided in the West Bay Nippers Manual, West Bay Nippers Information Guide, And West Bay Nippers Line Group. Additional information is available at www.westbay.tw. I have read and understood all the important information provided to me.
16. 我同意遵守賽事規則和所有官員的指示。 我承認重要信息在 West Bay Nippers 手冊、West Bay Nippers 信息指南和 West Bay Nippers Line Group 中提供。 如需更多信息，請訪問 www.westbay.tw。 我已閱讀並理解提供給我的所有重要信息。
17. I acknowledge that the Event Organizer may change the Event activities without notice if the Event Organizers deem this necessary. I also recognize that the event organizer may cancel the Event due to weather conditions, safety considerations, terrorism, or ‘acts of god.’
17. 我承認，如果活動組織者認為有必要，活動組織者可以在不通知的情況下更改活動活動。 我也知道活動組織者可能會因天氣狀況、安全考慮、恐怖主義或“不可抗力”而取消活動。
18. I declare that:
18.1 I am not subject to any criminal investigation
18.2 I do not presently have any charges connecting to a severe criminal conviction against my name
18.3 I have not been convicted of any serious criminal offense.
18. 我聲明：
18.1 我沒有受到任何刑事調查
18.2 我目前沒有任何與針對我的名字的嚴重刑事定罪有關的指控
18.3 我沒有被判犯有任何嚴重的刑事罪行。
19. Safeguarding participants: I will seek to protect all other members from all abuse and child abuse, including grooming.
19. 保護參與者：我將努力保護所有其他成員免受所有虐待和虐待兒童，包括美容。
20. I acknowledge that the West Bay Nippers Club strives to create and maintain a member, practices the Code of Conduct, and adheres to the policies and procedures that are endorsed, understood, and implemented by all. I agree to use my best endeavors to develop and grow such a culture. I agree to be bound by and comply with the safeguarding policies and Code of Conduct. I will assist agencies and people in authority when dealing with children and young people.
20. 我承認 West Bay Nippers Club 努力創建和維護會員，實踐行為準則，並遵守所有人認可、理解和實施的政策和程序。 我同意盡我最大的努力來發展和發展這種文化。 我同意受保護政策和行為準則的約束並遵守。 在處理兒童和青少年問題時，我會協助機構和權威人士。
21. Release & Indemnity: Where I have been negligent, have committed a criminal offense, and/or otherwise intentionally failed or refused to comply with the West Bay Nippers Club and The Event rules as a member or application for membership I:
21.1 Release and will release the West Bay Nippers Club from all claims and lawsuits that I may have or may have had but for this release arising from or about my membership and/or participation in any West Bay Nippers Activities and The Event; and
21.2 Indemnify and will keep indemnified the West Bay Nippers Club to the extent permitted by law in respect of any claim by any person arising as a result of or in connection with my membership and/or participation in any West Bay Nippers Activities.
21. 免責和賠償：如果我疏忽大意、犯下刑事罪行和/或以其他方式故意不遵守或拒絕遵守西灣鉗子俱樂部和活動規則作為會員或申請會員我：
21.1 免除並將免除我可能擁有或可能擁有的所有索賠和訴訟，但由於我的會員資格和/或參與任何西灣鉗子活動和事件而引起或與此有關的索賠和訴訟； 和
21.2 在法律允許的範圍內，就任何人因我的會員資格和/或參與任何 West Bay Nippers 活動而引起或與之相關的任何索賠，賠償並將繼續賠償 West Bay Nippers 俱樂部。
22. Privacy: By completing this form, I consent to the West Bay Nippers Club using, disclosing, and storing my personal information. The West Bay Nippers Club and the Event collects and holds data on members and, where members are under 18, their parents/guardians for the sole purposes of West Bay Nippers Club activities and administration. The information I have supplied in this form is necessary for adequately managing West Bay Nipper’s administration of surf safety and related activities.
22. 隱私：通過填寫此表格，我同意 West Bay Nippers Club 使用、披露和存儲我的個人信息。 West Bay Nippers Club 和活動收集和保存會員數據，如果會員未滿 18 周歲，他們的父母/監護人的數據僅用於 West Bay Nippers Club 活動和管理。 我在此表格中提供的信息對於充分管理 West Bay Nipper 的衝浪安全管理和相關活動是必要的。
23. The West Bay Nippers Club may share my information with other organizations. My data may also be used to notify me of different events and news and to offer me the provision of services, including by third‐ party providers. I acknowledge that if I do not desire to accept promotional material from sponsors and third parties, I may advise in writing.
23. West Bay Nippers Club 可能會與其他組織共享我的信息。 我的數據也可能用於通知我不同的事件和新聞，並為我提供服務，包括由第三方提供商提供的服務。 我承認，如果我不想接受來自讚助商和第三方的宣傳材料，我可以書面形式提出建議。
INDEMNITY AND CONSENT 賠償和同意
- I acknowledge that I have read & understand this indemnity and consent form and consent to be bound by the following:
- I accept that I and/or my child or the child in my care will participate in and be exposed to various risks and dangers associated directly or indirectly with the West Bay Nippers Club activities and the Event.
- I realize the activities require me and/or my child or the child in my care to be in good physical and mental condition and are in such a condition, having checked with my medical practitioner.
- I agree to obey at all times, whether participating in any activity or not, any warning notices and instructions of the West Bay Nippers management and/or the person in charge of the Event.
- I also acknowledge that the West Bay Nippers management and/or the person in charge of the activity may, in his/her sole discretion, decide to: Cancel, terminate or curtail any activity at any stage for whatever reason the West Bay Nippers management and/or the person in charge of the Event in his/her sole discretion deems fit.
- 我確認我已閱讀並理解本賠償和同意書並同意受以下條款約束：
- 我接受我和/或我的孩子或我照顧的孩子將參與並暴露於與 West Bay Nippers Club 活動和活動直接或間接相關的各種風險和危險。
- 我意識到這些活動要求我和/或我的孩子或我照顧的孩子處於良好的身心狀態，並且在與我的醫生核實後處於這種狀態。
- 無論是否參加任何活動，我同意始終遵守 West Bay Nippers 管理層和/或活動負責人的任何警告通知和指示。
- 我還承認，West Bay Nippers 管理層和/或活動負責人可自行決定： 出於任何原因，West Bay Nippers 管理層和 /或活動負責人全權酌情認為合適。
- I certify that all details provided are true and correct.
- I acknowledge that I can’t amend the West Bay Nippers Club membership declaration. If I amend my application, it won’t be accepted by the West Bay Nippers Club.
- I have read, understood, recognize, and agree to the above information, including the warning, exclusion of liability, release & indemnity relating to a severe criminal offense.
- I agree to be bound by and to comply with the West Bay Nippers constitution and any regulations and policies made under it.
- 我證明所提供的所有詳細信息均真實無誤。
- 我承認我無法修改 West Bay Nippers Club 會員聲明。 如果我修改我的申請，West Bay Nippers Club 將不會接受。
- 我已閱讀、理解、認可並同意上述信息，包括與嚴重刑事犯罪相關的警告、免責、免責和賠償。
- 我同意受 West Bay Nippers 章程以及根據其製定的任何法規和政策的約束並遵守。
I agree to the following:
我同意以下內容：
- My child taking part in the stated activity
- West Bay Nippers Club keeping a record of this form for health and safety reasons
- Any medical treatment my child may need to be given in an emergency.
- My child being filmed or photographed during the activity, with the possibility that these photographs/media recordings may be used for publications or marketing publicity. West Bay Nippers Club will take all steps to ensure these images are used solely for their intended purposes.
- 我的孩子參加了規定的活動
- 出於健康和安全原因，West Bay Nippers Club 保留此表格的記錄
- 我的孩子在緊急情況下可能需要接受的任何醫療。
- 我的孩子在活動期間被拍攝或拍照，這些照片/媒體記錄可能被用於出版物或營銷宣傳。 West Bay Nippers Club 將採取一切措施確保這些圖像僅用於其預期目的。
Note: If consent is not given, the West Bay Nippers Club will not use any images taken during the activity that contains the child/young person. I understand that my child needs to follow the participant’s Code of Conduct and safety rules so that the West Bay Nippers Club can keep them and other children safe. I am the parent/guardian of the applicant. I authorize and consent to the applicant undertaking the West Bay Nippers activities and The Event. In consideration of the applicant’s membership being accepted, I agree to be responsible for the applicant’s behavior and agree to accept in my capacity as parent/guardian personally; the terms set out in this membership application and declaration, including the provision by me of a release and indemnity in the terms set out above. In addition, I agree to be bound by and to comply with the West Bay Nippers Club constitution and any regulations and policies made under it. I have read, understood, acknowledge, and agree to the declaration and application and conditions of membership, and I consent to the declaration and application for membership of the applicant.
注意：如果未徵得同意，West Bay Nippers Club 將不會使用在包含兒童/青少年的活動中拍攝的任何圖像。 我了解我的孩子需要遵守參與者的行為準則和安全規則，以便 West Bay Nippers Club 可以保護他們和其他孩子的安全。 我是申請人的父母/監護人。 我授權並同意申請人進行 West Bay Nippers 活動和活動。 考慮到申請人的會員資格被接受，我同意對申請人的行為負責，並同意以我的家長/監護人身份親自接受； 本會員申請和聲明中列出的條款，包括我在上述條款中提供的免責聲明和賠償。 此外，我同意受 West Bay Nippers Club 章程以及根據其製定的任何法規和政策的約束並遵守。 本人已閱讀、理解、承認並同意入會聲明及申請及條件，本人同意申請人的入會聲明及申請。
Parent’s/Guardian’s/Volunteer’s Full English Name or Parent’s/Guardian’s/Volunteer’s Full Chinese Name
家長/監護人/義工的英文全名或家長/監護人/義工的中文全名
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I have read this waiver of liability, assumption of risk, and indemnify, fully understand its terms, and understand that I am giving up my rights, including my right to sue. I acknowledge that I am signing the agreement freely and voluntarily and intend by my signature to a complete and unconditional release of liability to the greatest extent allowed by law.
我瞭解並同意，參加此次活動或項目，可能存在一定風險，包括身體受傷、財物損失、或其他損害。我承擔參加此次活動或項目的全部風險，並同意自己或我的繼承人、代理人、繼承人、受讓人或其他人士不會提出任何索賠、控訴或訴訟，對組織者或合作方因此產生的任何損失、費用、責任或損害負責。
Parent’s/Guardian’s/Volunteer’s signature: 家長/監護人/志願者簽名：（紙質版）
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Date: (year, month, date) 日期：（年、月、日）____________________________