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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