Term of knowledge of risks and authorization to use images

We are a family owned and operated business.

We are a family owned and operated business.

We are a family owned and operated business.

Full name: _________________________________________ Cpf: _____________-______ Birth Date: ____ / _____ / _______

City: ___________________ UF _____ Tel / Cel. _______________________ Email.__________________________________

Medical Data:

Allergic to Medicines? ____________________ Heart Disorder? ______________________

Epilepsy and Seizures? _____________________________
Do you use medication or drugs? ___________What medication? ______________________________

Emergency Call: _______________________ Health Insurance: ________________________

Nervous or Mental Disorder? ______________________________ Surgery? ________________Blood type_________

Statement of responsibility

I, ____________________________________________ bearer of RG no. __________________I declare for the proper purposes, that I am participating in the activity "DOUBLE FLIGHT OF INSTRUCTION PARAPENT" of my own free will and I am aware of the risks inherent in the practice of flying in Paragliding. I also declare to be aware that when practicing the activity, I assume full responsibility for the damages that this practice may cause to me or to third parties, I am fully aware that the vehicle is not approved by the aeronautical authority and my participation is on my own and risk. I also declare that I am physically and clinically able to participate in such an activity. I assume all risks in practicing the double paragliding flight, exempting the pilot as well as the company RANEY MODENEZE DE FREITAS 12287182705 and the entities involved in the sport, from any civil or criminal responsibilities in case of any physical or moral injury and its consequences. In view of the knowledge of these facts, and out of consideration for accepting this responsibility, I, for myself and for anyone who represents myself in my favor, renounce the company "RANEY MODENEZE DE FREITAS 12287182705 and its pilots" and their successors of all civil and / or criminal claims or liabilities for any accident / incident that may occur to me.

We are a family owned and operated business.

I AUTHORIZE the use of my image in any and all material including photos, video, documents and other means of communication, to be used in promotional and institutional campaigns of the Paragliding Double Flight with RANEY MODENEZE DE FREITAS 12287182705, based at Rua Alfredo da Luz, 146, Baixo Guandu, ES, CEP: 29730-000, registered with the CNPJ under number 23190999 / 0001-84, whether these are intended for disclosure to the general public and / or only for the internal use of this institution, as long as there are no distortion of its purpose.

This authorization is granted free of charge, covering the use of the aforementioned image throughout the country and abroad, in all its modalities and, in particular, in the following ways: (I) out-door; (II) busdoor; brochures in general (inserts, direct mail, catalog, etc.); (III) presentation folder; (IV) advertisements in magazines and newspapers in general; (V) home page; (VI) posters; (VII) back-light; (VIII) electronic media (panels, video tapes, television, cinema, TV program, among others).
As this is the expression of my will, I declare that I authorize the use described above without having anything to be claimed for rights related to my image or any other, and I sign this authorization.

We are a family owned and operated business.

______________________________________
Passenger Signature
Signature of Father or Mother in case of children under 18
(Prohibited for children under 12)

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