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Angol Management Services CC trading as

Skydive Pretoria

Wonderboom Airport, Pretoria, South Africa

www.skydivepretoria.com

INDEMNIFICATION AND CONSENT

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
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First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information

Nationality *

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*
Check to receive manifest, information, and news by e-mail.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Skydiving Information

Total number of jumps. *

Time in sport *

Jumps in last 12 months *

Jumps in last month *

Make of container or Club gear *

Main canopy make and size *

Reserve canopy make and size *
Make of AAD*

Weight in kilograms *

Date of last reserve pack

Date of last jump *
Have you done a Tandem Skydive?*
No
Yes
PASA Details
Are you a paid up PASA member*
No
Yes

PASA number or Foreign Association number or Student *

Licence Number
What current ratings do you hold?
Jumpmaster
FS Coach
AE Coach
CP Coach
SL Instructor
AFF Instructor
Tandem Master
Pro Rating
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. *
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.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

Nationality *

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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