QR / Bungee Zator

Jumper card

Fill out the form before your jump. The data goes to the AdrenaLine crew and helps us get you through the briefing smoothly.

Participant details

Completed by the jumper or legal guardian.

Full name Email Phone Age Weight (kg) City / town

I am completing this card as the jumper's parent or legal guardian.

Health declaration

Choose YES or NO for every point.

Other injuries, surgeries or information for the instructor

Rules and consents

Read the rules, then confirm the declarations.

Bungee jumping rules

I. General provisions

The organiser of bungee jumps is Aline Sp. z o.o. based in Chrzanów, NIP 628-227-60-05. Admission to a jump requires signing a declaration of good health, reading these rules and accepting their provisions.

Adults may jump. Minors over 12 years old and weighing more than 50 kg may jump only with written consent from a parent or legal guardian, signed in the presence of an instructor. The organiser may refuse admission to a jump, especially for safety reasons.

II. Technical and physical requirements

Participants must weigh between 50 kg and 110 kg. The jumper must wear tied sports shoes. Before the jump, pockets must be emptied and objects that could fall out or create danger must be removed.

III. Safety and health

People under the influence of alcohol, intoxicants, psychotropic substances or medication limiting concentration must not jump. The jumper confirms that there are no medical contraindications listed in the jumper card and reports all injuries or symptoms to the instructor.

IV. Jump procedure

All preparation and harness fitting is performed only by the instructor. The instructor counts down: 3, 2, 1, BUNGY! If the jumper does not jump after the third countdown, the service is considered completed. Grabbing the bungee cord with hands during the jump is strictly forbidden.

V. Liability, image and GDPR

The organiser is not liable for damage resulting from hiding health information, failing to follow instructor commands or deliberately breaking safety rules. Personal data is processed to provide the service and ensure safety.

I have read and accept the Bungee Jumping Rules. I acknowledge that I jump at my own responsibility, aware of the nature and risks of this activity. I confirm that I am not under the influence of alcohol or intoxicants. I confirm that the instructor has briefed me on jump technique and safety rules. I consent to personal data processing for the service by Aline Sp. z o.o. I want to receive information about AdrenaLine events and offers by email.

Consent to publish photo/video image Yes, I consent No, I do not consent

Signature

Sign with your finger or stylus on the screen.