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Peter Lawson Cup 2020

Competitor Registration

INDEMNIFICATION AND CONSENT

Angol Management Services (Pty) Ltd t/a Skydive Pretoria requires that the following declaration be completed by ALL participants.

 

I the participant hereby confirm and declare the following:

I declare that I am at my sound and sober senses and that the information herein is correct.

I Agree

Parachuting and skydiving is of a potentially hazardous nature and by participating therein persons put themselves at risk of either injury or death.

I Agree

I hereby indemnify the organisers and staff of Skydive Pretoria, South African Skydiving School, instructors and chief instructor, tandem masters, packers, dropzone operators, aircraft operators, pilots, crew, Wonderboom National Airport and City of Tshwane Metropolitan Muncipality (CTMM) against any or all claims whatsoever directly or indirectly resulting from injury or fatality which has anything to do with any disciplines, operations or procedures, connected to or relevant to the sport of parachuting and skydiving.

I Agree

I am fully aware of the limitations of any dropzones and declare that registering for a tandem, first jump or sport parachuting and skydiving, is done so at my own free will and I accept the conditions laid down by the organisers.

I Agree

I therefore also undertake to abide by the basic safety regulations, regulations and procedures as laid down by PASA / ADZO. (Parachuting Association of South Africa / Association of Dropzone Operators)

I Agree

 

Please select who will be participating...
AdultMinor
First Participant's Name
First Name*
Last Name*
Phone*
Select Gender
First Participant's Date of Birth*
Date of Birth
Information
Work phone number
Home phone number
Postal address if different from residential
First Participant's Signature*
Participant's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address
Email*
Confirm Email*
Emergency Contact
First Name*
Last Name*
Emergency Contact's Phone Number*
Parent or Guardian's Driver's License / ID Card
Driver's License / ID Card Number*
Issuing State*
Skydiving Information
Total Number of Jumps. *
Total Jumps Last 3 Months *
Total Jumps Last Month *
Main canopy size *
Reserve canopy size *
Weight in kilograms *
Date of last reserve pack
Date of last jump *
PASA Details
Are you a paid up PASA member*
No
Yes
PASA Number *
Licence Number *
Current Drop Zone *
Medical Aid or Medical Insurance Details
Do you have medical aid or medical insurance cover?*
No
Yes
Medical Aid or Medical Insurance Provider. Type NA if none. *
Medical Aid or Medical Insurance Member Number. Type NA if none. *
COMPETITION DETAILS
SELECT EVENTS YOU INTEND TO COMPETE IN. *
Camera
Artistic Events VFS 1 Junior / 1 Senior in team
Canopy Piloting - Accuracy
Formation Skydiving 4 Way Randoms
Formation Skydiving 2 Way 1 Junior / 1 Senior in team
Formation Skydving 8 Way Speedstar
Wingsuiting
BANK DETAILS AND PAYMENT
Select registration paid *
Registration R150 paid before 22 September 2020.
Competitor registration must be paid into the following bank account:
Name: Angol Management Services (Pty) Ltd
Bank:    Nedbank Ltd
Branch:  115734
Account: 1160468907
Type: Current Account
Use your name and PASA number as reference (eg John Doe 1234). Please do not include any other payments with this payment. Email proof of payment to ange@skydivepretoria.com

Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name
First Name*
Last Name*
Phone*
Select Gender
Parent or Guardian's Date of Birth*
Date of Birth
Information
Work phone number
Home phone number
Postal address if different from residential
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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