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法律效力聲明 · 未成年須法定代理人共同簽署

課程參與同意書暨風險告知書 Participation Agreement

激流獨木舟課程雙語安全聲明 River Kayaking Course Release Form

本文件為激流獨木舟課程之安全防禦、健康聲明與責任免除同意書。請仔細閱讀並據實填寫所有資訊,未滿十八歲者須由法定代理人共同簽署。

This document is the safety, health, and liability release agreement for river kayaking. Please read and fill in all fields. Minors require a parent/guardian signature.

參加者基本資料 Participant Information

請確實填寫個人通訊與緊急聯絡人欄位

Please fill out your personal and emergency contact details

游泳能力與健康狀況調查 Health and Capability Survey

請如實勾選您的水中自救能力、划船經驗與目前生理健康狀況

Please answer the following screening items honestly

游泳能力評估 / Swim Capability Assessment (必填,可複選 / Required)

獨木舟經驗調查 / Kayaking Experience Survey

過去是否曾接觸獨木舟活動? / Previous Kayaking Experience (必填,可複選 / Required)

累計划船次數 / Total Paddling Days (必填,單選 / Required)

是否曾學習翻滾? / Learned Kayak Roll?

是否曾參加急流救援課程? / Swiftwater Rescue?

最高參與過的河流難度 / Highest Whitewater Class (單選 / Single-select)

健康狀況調查 / Health Survey (必填 / Required)

心血管疾病 / Cardiovascular disease
高血壓 / Hypertension
氣喘 / Asthma
癲癇 / Epilepsy
糖尿病 / Diabetes
重大手術病史 / Major surgery history
脊椎或頸椎疾病 / Spine / Neck conditions
肩膀、手肘、手腕傷害 / Upper limb injury
髖關節、膝蓋、腳踝傷害 / Lower limb injury
懷孕 / Pregnancy
目前是否有規律服用藥物? / Regular Medications
是否有藥物過敏? / Medical Allergies
是否有食物或昆蟲過敏? / Food or Insect Allergies

免責與安全聲明條款 Terms and Conditions

請逐條詳細閱讀下列聲明

Please read the following clauses carefully

健康狀況與醫療限制 / Health and Medical Restrictions

本人確認已依自身所知,如實提供與參與本課程安全相關之健康狀況、既有傷病、過敏及用藥資訊。如本人有醫師建議限制劇烈運動或水域活動之情形,或有其他可能影響活動安全之健康狀況,應於課程前告知主辦單位,以利評估是否需要調整活動安排或採取適當措施。

I confirm that I have truthfully disclosed, to the best of my knowledge, any medical conditions, existing injuries, allergies, medications, or other health information relevant to safe participation in this course. I will inform the organizers before the course of any medical advice restricting strenuous exercise or water activities, or any other health condition that may affect my safety, so that appropriate precautions or adjustments can be considered.

活動風險告知與承擔 / Assumption of Risk

本人了解,激流獨木舟及相關水域活動具有固有風險,即使參加者、教練及工作人員採取合理的安全措施,仍可能發生無法完全預見或避免的事故。

本人已了解本課程可能涉及船艇翻覆、落水、碰撞、水下困陷、倒木攔截、裝備故障、體力透支、失溫、天候及水文變化、偏遠地區救援延誤,以及身體受傷、永久失能或死亡等風險。

本人基於自由意志決定參加本課程,並願意承擔活動本身固有且無法完全消除的風險。但本條不構成對主辦單位、教練或其他相關人員依法應負責任之預先免除或限制;事故發生時,各方責任仍應依適用法律及具體事實判斷。

I understand that whitewater kayaking and related water activities involve inherent risks. Accidents may occur despite reasonable safety precautions taken by participants, instructors, and staff.

I understand that these risks may include capsizing, swimming in moving water, collisions, underwater entrapment, strainer hazards, equipment failure, exhaustion, hypothermia, changing weather and river conditions, delayed rescue in remote areas, serious injury, permanent disability, or death.

I voluntarily choose to participate in this course and accept the inherent risks of the activity that cannot be completely eliminated. This provision does not constitute an advance waiver or limitation of any liability that the organizers, instructors, or other relevant parties may have under applicable law. Responsibility for any incident shall be determined in accordance with applicable law and the specific facts of the case.

安全規範遵守 / Participant Responsibilities

本人同意遵守教練及工作人員之合理安全指示,正確穿戴規定之安全裝備,不於活動期間飲酒或使用影響判斷能力之物質,並不從事超出課程範圍或未經教練許可之危險行為。

如本人違反安全規範,或教練合理認為本人之行為可能危及本人或他人安全,教練得要求本人停止相關行為、調整活動內容,或終止本人繼續參與課程。因終止參與所生之退費或其他費用,應依課程約定、實際履約情況及適用法律處理。

I agree to follow reasonable safety instructions, wear the required safety equipment correctly, refrain from alcohol or substances that impair judgment, and avoid dangerous conduct outside the course scope or without the instructor's permission.

If I violate safety rules or the instructor reasonably determines that my conduct may endanger myself or others, the instructor may require me to stop the conduct, modify my participation, or terminate my participation in the course. Any refund or other financial consequences shall be determined in accordance with the course terms, the services actually provided, and applicable law.

緊急醫療授權 / Emergency Medical Authorization

如本人於活動期間發生意外、受傷或突發疾病,且無法及時自行表達意願或作成決定,本人同意教練及工作人員在合理可行範圍內協助聯絡緊急聯絡人、聯繫救援單位、安排送醫,並協助取得必要之緊急醫療協助。

本人了解,緊急救援、醫療、運送、後送及住院等費用,可能須由本人先行支付或依相關保險契約申請理賠。最終費用負擔及相關責任,仍依適用法律、實際情況及保險契約內容判斷。

If I suffer an accident, injury, or sudden illness during the activity and am unable to express my wishes or make decisions in a timely manner, I authorize the instructors and staff, where reasonably practicable, to contact my emergency contact, coordinate with rescue services, arrange transportation to a medical facility, and assist in obtaining necessary emergency medical care.

I understand that rescue, medical treatment, transportation, evacuation, and hospitalization expenses may need to be paid by me initially or submitted for reimbursement under an applicable insurance policy. Ultimate responsibility for such expenses and any related liability shall be determined in accordance with applicable law, the circumstances, and the relevant insurance policy.

保險說明與自行投保 / Insurance Information and Personal Coverage

本人了解,本課程於天然野溪開放水域進行,活動場域、活動性質及保單條款可能影響保險承保資格與保障範圍。主辦單位應就本課程實際投保之保險種類、保障範圍及相關限制,提供真實且適當之說明。

本課程費用不包含學員個人人身保險。主辦單位建議並要求本人於參加前確認已具備適用於本課程之保險保障,並特別確認意外身故、傷害醫療、緊急搜救及後送等項目是否承保,以及其保額、除外責任與理賠條件。

本人了解,未投保、保額不足或事故屬於保險契約除外責任時,可能導致本人無法取得全部或部分保險給付。保險保障之有無,不影響各方依法應負之責任;本人不得僅因簽署本文件,即被視為放棄依法享有之權利。

I understand that this course takes place in natural, open-water river environments, and that the activity location, nature of the activity, and policy terms may affect insurance eligibility and coverage. The organizers should provide accurate and appropriate information regarding any insurance actually maintained for this course, including its coverage and limitations.

The course fee does not include personal accident or medical insurance for participants. Before participating, I am advised and required to confirm that I have appropriate insurance coverage for this course, including whether accidental death, injury-related medical expenses, emergency search and rescue, and evacuation are covered, together with applicable limits, exclusions, and claim conditions.

I understand that having no insurance, insufficient coverage, or an incident falling within a policy exclusion may result in reduced or unavailable insurance benefits. The existence or absence of insurance does not alter any liability imposed by applicable law, and signing this document does not constitute a waiver of any rights that I may have under applicable law.

照片與影像授權 / Photo and Video Consent

本人知悉,課程期間可能拍攝照片、影片或其他影像紀錄。本人同意主辦單位將相關影像用於課程教學紀錄及必要之認證申請。

如主辦單位欲將可辨識本人身分之影像用於網站、社群媒體或招生宣傳,應另行取得本人同意。本人不同意宣傳用途,不影響本人參加課程。影像之使用、保存及撤回同意之處理,依適用法律及相關告知內容辦理。

I understand that photographs, videos, or other visual recordings may be taken during the course. I consent to the organizers using relevant recordings for course documentation and necessary certification applications.

Separate consent must be obtained before using images in which I can be identified for websites, social media, or promotional purposes. Declining promotional use will not affect my participation in the course. The use and retention of recordings, and the handling of requests to withdraw consent, shall be subject to applicable law and the relevant privacy notice.

ACA 認證說明 / ACA Certification Notice

本人了解:課程結束後是否取得 ACA 認證資格,將由授課教練依 ACA 標準進行評估。參與課程並不保證取得 ACA 證書或認證資格。

Successful participation in the course does not guarantee ACA certification. Certification decisions are made solely according to ACA standards and instructor evaluation.

爭議處理 / Governing Law

本同意書之解釋與適用,依中華民國法律辦理。如因本課程衍生爭議,雙方合意以臺灣臺中地方法院為第一審管轄法院;但消費者保護法或其他法律另有強制管轄規定者,從其規定。

This agreement shall be governed by the laws of Taiwan. Any dispute arising from this agreement shall be submitted to the Taichung District Court as the court of first instance, unless mandatory consumer protection laws specify otherwise.

確認與簽署 Acknowledgement and Signature

本人已詳閱本同意書全部內容,充分了解其意義及法律效果,並確認所有資料填寫屬實。

I have carefully read and understood this agreement and voluntarily agree to its terms.

請在此簽名 / Sign Here

個人資料蒐集、處理及利用告知聲明 / Privacy Policy & Personal Data Notice

依據《個人資料保護法》第 8 條規定,向您告知下列個人資料保護宣告事項,當您填寫並提交表單時即視為同意本聲明:
In accordance with Article 8 of Taiwan's Personal Data Protection Act, you are hereby notified of the following data collection and processing terms upon submission:

  • 蒐集目的 / Purpose:激流獨木舟課程安全管理、意外保險辦理、緊急醫療聯繫、ACA 認證申請與登錄。
    Course safety management, insurance coverage, emergency response, and ACA course certification.
  • 個資類別 / Categories:姓名、身分證字號/護照號碼、出生日期、聯絡電話、電子郵件、通訊地址、緊急聯絡人關係與電話,以及水中自救能力與個人健康狀況(特種個資)。
    Name, ID/Passport, DOB, contact phone, email, address, emergency contact, and special category medical/swim data.
  • 利用對象與期間 / Scope & Period:限於本課程執行與認證申辦必要期間,於台灣地區內由主辦單位及保險承保機構處理與利用。
    Processed strictly within Taiwan by organizers and underwriters during the course operation and certification period.
  • 當事人權利 / Data Subject Rights:您隨時得依個資法第 3 條行使查詢、閱覽、製給複製本、補充、更正、請求停止蒐集/處理/利用或請求刪除之權利。
    You may exercise rights to inquire, inspect, duplicate, supplement, correct, or request deletion per Article 3 of the Act.
  • 不提供之影響 / Voluntary Disclosure:您得自由選擇是否提供,惟若拒絕提供必要個資,主辦單位將無法為您辦理保險及拒絕您參與本課程。
    Provision is voluntary; however, withholding required data prevents insurance enrollment and course participation.
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