JSC MEMBER APPLICATION FORM
Title, Name and Surname *
Your answer
Postal Address *
Your answer
E-mail Address *
Your answer
Cellphone Number *
Your answer
ID Number *
Your answer
Occupation *
Your answer
Medical Aid Details (Name, Membership number + Contact Number) *
Your answer
Next Of Kin (Name, Relationship and Contact Number) *
Your answer
Reserve Repack Date *
Your answer
Weight *
Your answer
Canopy Size *
Your answer
PASA Number *
Your answer
Time In Sport *
Your answer
Number Of Jumps *
Your answer
Existing License Numbers *
Your answer
Current Ratings Held *
Your answer
Medical - Do you suffer from, or are you being treated for: *
Yes
No
Epilepsy
Diabetes
Heart Condition
Blackouts/Dizzy Spells
High Blood Pressure
Low Blood Pressure
Asthma
Ear Problems
Dizziness
Infections
Eyes
Corrective Lenses
Single Eye/ Limited Vision
Previous Fractures *
Yes
No
Legs
Ankles
Back
Wrist
Shoulders
Briefly describe above injuries if any:
Your answer
Substances *
Yes
No
Are you currently on any medication?
Are you currently addicated to alchool and/or drugs?
If yes to above, briefly describe
Your answer
Blood Type and Allergies *
Your answer
Terms and Conditions
I do hereby place on record that I will participate in all the activities at Johannesburg Skydiving Club (JSC) at my own risk, and, being aware of all the hazards involved in parachuting, do hereby for myself, my heirs, executors and assigns, indemnify and hold JSC and/or its members harmless against all claims for damages at the instance of myself and/or any member of my family for any loss or injury sustained by me as a result of anything done or omitted by JSC and/or its members and/or its servants and/or its agents up to and including my date of application for membership and/or during the period of my membership.
I hereby undertake to abide by the Club rules, as amended by the Committee from time to time, and acknowledge having received a copy of said rules (available at www.jsc.co.za).
By ticking yes below you agree to the above T&C's and there by confirming your JSC membership at R660.00 yearly fee's: *
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