Registration Form for Paraglider Pilots

Personal Information

Name:

Father/Mother’s Name:

Address:

Passport Number (mandatory for foreign national):

Date of Arrival in India:

National Certification/IPPI Card Level (enclose copy):

Technical evaluator’s remark on certification level and his/her signature:

Equipment Information

Make and Model of Paraglider:

EN/DHV/AFNOR/SHV certification category:

(if testing a prototype please attach authorization letter from the manufacturer)

Make and Model of Reserve:

Insurance details if any:

Declaration

I declare that I am in good physical and mental health.

I understand the nature of the sport and risk involved with flying Paragliders. I choose to do so at my
own risk and release Assam Government Administration, it’s Appointed Committees and Assisting Locals
of any liability.
I further understand and declare that in case of an accident and search, rescue and medical treatment
would be at my own cost.

Signature: Date:

Witness 1: Witness 2:
(Signature and Address) (Signature and Address)

Free Flyer Card

Name Card No 1-12/2023

Nationality DTO Assam

Date
Address

Validity

Passport No

Signature Issuing Authority

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Indemnity Bond
1. I have been informed and I am aware that Paragliding can be dangerous and includes many risks
and dangers, including but not limited to the hazards of travelling by Paragliding accident or
illness in remote places, without medical facilities, forces of natures, act of God, extreme
weather conditions, physical exertion for which I may not be prepared and evacuation
difficulties, should I be injured or disabled. I have been informed and am aware of these and
other inherent risks, and or the proposed trips and acknowledge that an enjoyment of
adventuring beyond normal safety of home and work is in part the reason for my participation
on this trip.

2. I hereby release, waive indemnify and agree not sue the operator Government of Assam for all
or any liability to me, my personal representatives, heirs, assigns, and next of kin for any losses,
damages, or injuries or any claim or demand on account of any injury to my person or property,
or on account of my death resulting from any cause including negligence of operator, or others,
while I am participating in Adventure. I further agree that I will assume the risk and will release
operator of any liability for any injury or damage to my body or property or my death due to any
negative failure to obtain or any administer appropriate rescue operations in any event of injury
or mishap, including failure to obtain adequate medical services, to evacuate, to supply
treatment, medicine, or trained rescue personnel.

3. I further agree that State Government will not cost any expenditure incurred in rescue/medical
in case of accident or emergency.

4. I expressly acknowledge and agree that adventure travel, including the operators adventure trip
in which I am participating can be dangerous and involves serious unprecedented bodily injury,
property damage and death and I intend the forgoing waiver release of operator to be as board
and inclusive as permitted by law, that I am not relying on oral or written representation or
operator regarding safety, that I am entering this agreement at my own free will.

5. I further agree that I will have no liquor or illegal drugs in my possession when participating in
Paragliding Trip.

6. I have read and understood all the terms of this liability and assumption of risk and agree to it of
own free will and without reservation.

Signature:

Participant’s Name:

Address:

Date:

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