参加高空弹跳活动者登记表

PARTICIPANT INFOPAGE

日期Date: 体重Weight: Kg 血压Blood pressure:

中文姓名Chinese name: 英文姓名English name:

性别Sex: 男M. 女F 出生年月Birthday:

职业地址Occupation: 学生Student 学校School:

通讯地址Mailing add: 邮政编码Post code:

电话(O)公司： （H）家： 手机：

保险受益人Beneficiary: 电话号码Tel:

特别约定Special Agreement

北宁市统景体育健身有限公司高空弹跳站提供正确高空弹跳指导及安全之高空弹跳装备，并为所有参加高空弹跳的人士投保，以确保每位参加者之权利。所有参加高空弹跳的人士，必须遵守高空弹跳教练的安全指导且在健康情形下进行弹跳，凡患有心脏病、高血压、脑血管病、神经错乱、哮喘、眼睛疾病、眼睛受过外部损伤、骨折史、颈椎患者、酗酒、吸毒者以及孕妇等不适合高空弹跳的人，禁止参加弹跳。未满十八岁者需监护人同意。

本高空弹跳站的所有有价票据一经售出，不可他人代替，恕不退票。

我 已全文阅读上述规定，自愿参加高空弹跳。我愿意遵守高空弹跳之安全规定并遵守教练的指导，我相信这是安全且刺激的活动，倘若因我个人未遵守高空弹跳之规定而发生任何意外，我愿意负责一切后果，绝不影响他人，更不可因此控告教练，恐后无凭，特与高空弹跳站签立此项特别约定。

Beining Tongjing P.E Gymnastics Bungee Site shall be responsible for providing proper instructions and safe equipment.A necessary insurance coverage had been arranged for the participants. All participants shall be in good healthy and follow the conditions of the jumpmasters.Persons susceptible to any of following conditions:high blood pressure, heart attack, , cerebral haemorrhage, ,asthma, eye illness, external scathe of eyes ,epilepsy, Cervical and spine patients, pregnancy,ligament injuries,or chemically altered are prohibited from participating in the activities. Participants under 18 shall get approval from their guardian.

I wish to participate in this activity of my own free will and desire. I acknowledge that the Bungee Site is a skilled activity of good healthy and that I am capable of participating.When as the site is responsible for providing the proper instruction and equipment,the participate is responsible for following the conditions and rules set forth by the jumpmaster. I am willing to participate in this activity and agree to follow the instructions given to me.If I fail to follow the instructions given to me and as a result cause injury to others or myself,I shall not claim compensation from the operator

or others.It’s my own free will to sign this special agreement with Bungee Site.

参与者签字Participants signature： 身份证号码ID#： 监护人签字Guardian signature: 身份证号码ID#：