SWORN DECLARATION

NAME:
REPRESENTED BY1:
NATIONALITY:

PASSPORT:
BIRTHDATE:

I have been informed that the age allowed to participate in the indicated risky
activities as well as to be able to sign this document is from 18 to 60 years, to be
with the full capacity and to be in optimal health conditions.

I DECLARE UNDER THE OATH THE FOLLOWING:

1. That by my own will and initiative, I have come today to take part in
_______________________________________________________________________,
(the, "Activity" o "Activities") or because it is my intention to find out more
about this.
2. That I am aware of the activity to be performed being considered risky.
3. That upon signing this declaration, I agree to comply with each and every
instruction of the guide before, during and after the Activity, in case of non-
compliance with any of them, I declare that I do so under my full responsibility
and I assume the consequences that this may entail, release, indemnify and
defend the guide, South America Experiences S.A.C. ("Exploor"), including its
staff and any third party that could be affected directly or indirectly.
4. That I have been duly informed about the risks involved in the participation in
this Activity, as well as the need to observe and cohere to the safety rules for
the participation. I also declare that I am aware that this is a risky activity that
involves all kinds of risks, including risks such as permanent injuries and / or
fatality.
5. That I comply with the physical needs and requirements for the participation
in the Activity and that I am totally healthy. I also assume the risks of my
participation in the Activity described. Therefore, I fully release and waive any
indemnification claim against Exploor, its representatives and employees and
all involved in any claim for death or accident, injury or permanent damage of
any kind that come up before, during and after my voluntary participation in
the Activity. I declare and hold innocent the aforementioned persons and
entities of any claim against them as a result of my actions during the Activity.
6. That I am informed that according to articles 1970 and 1972 of the Peruvian
Civil Code, any damage to my person caused by my own or third parties'
imprudence, or by acts contrary to safety regulations, acts of God or force
majeure will not be responsibility of Exploor or anyone related to Exploor..
7. That I assume full responsibility for any present or future damage that I may
suffer as a result of the Activities mentioned above, the use of the facilities or
my participation in those. Therefore, I understand that Exploor does not
provide any life, medical or liability insurance for any illness, accident, injury
or damage that could appear in relation with my participation in the Activity
1
Note: Signature of the representative in case the participant is underage or has a disability, always
considering that the guide must allow their participation in the Activity prior.
 that is about to be performed. If I wish to be insured against any kind of risk, I
should get one on my own. I will pay my own expenses related to medical
assistance and all medical expenses subsequent to my participation in this
Activity, for any illness, accident or injury linked to it.
8. I also authorize Exploor to provide, through medical personnel, medical
emergency treatment and transportation to the appropriate health center. This
authorization does not mean an obligation to Exploor to provide such medical
services. All costs related to any medical treatment will be covered and / or
reimbursed by me.
9. That I agree to indemnify and exempt all responsibility from Exploor to its
representatives, employees and third parties for any liability, against any type
of claim arising from any damage caused to third parties by my negligence,
incident, accident or violation of the safety rules, as well as by death or
accident, injury or permanent damage of any kind brought before, during and
after my participation in the Activity that I will perform. I declare and hold
innocent the aforementioned persons and entities of any claim against them
as a result of my actions during the Activity.
10. I formally authorize Exploor to take photos and / or make recordings of me
before, during and after the execution of the Activity in order to publish them
in the media channels that it considers appropriate, having the prior
authorization from me, in order to do so, perpetual and worldwide, as a
promotion or publicity. The prior authorization is given with an “X” in the box
below this paragraph and my signature on this document. In case you’re
willing to share the content rights of the pictures and recordings taken before,
during, and after the execution of the Activity, please mark the following box
with an "X" (not mandatory).

11. If any of the points included in this legal declaration is declared as being
invalid, the other points of this legal declaration will remain completely valid.
12. Finally, through my acceptance of the contents of this document, I certify that
my declaration is valid and must be accepted by Exploor.

Cusco, _____ de __________ de 2018

_________________________
Signature and fingerprint of participant or representative