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21-01-2024 utai 02-02-2024
Type of trip / course *
Current license Mountain / Winch
Flights/hours Mountain/Winch/Coastal *
BHPA/DHV/KNVvL member number
Model and size
First name *
Last name *
Street and House number *
Postcode and City *
Telephone number (mobile) *
Email address *
Date of Birth (dd-mm-yyyy) *
Weight (in kg.) *
Height (in cm) *
Comments / Specifics
Telephone number *
Policy number *
Policy number *
First and last name *
Paragliding is a risk sport. Action Paragliding BV strives to create a safe environment and good guidance for practicing paragliding. The nature of paragliding involves a certain risk and therefore participation in paragliding activities can lead to injuries, permanent disability or death.
Errors of the undersigned, (student) pilots, employees and other people involved, material failure and weather conditions, can lead to an accident. The undersigned accepts these risks and the consequences of a possible accident. The undersigned declares that he, nor any other (legal person) on his behalf, will hold Action Paragliding BV, or persons associated with Action Paragliding BV, liable for any accident or damage as a result of paragliding activities in the broadest sense of the word.
I have filled in and checked all data truthfully
I have read and agree to the Disclaimer (**).
I have read and agree to the Terms and Conditions (**).
I meet everything that has been stated in the Own Medical Statement (**), or I have another valid medical certificate.
(*) = Mandatory field
(**) = Dutch only; English under construction