OBRAZAC O PREUZIMANJU ODGOVORNOSTI

Ja_________________________________________,sa JMBG:______________________,
ul.______________________br._____ iz ______________________ ovim putem
izjavljujem:

1. Da sam razumio da je aktivnost vožnje kajaka ekstreman sport, te da postoji opasnost od

povreda i nesrećnih slučajeva. Ja izričito i dobrovoljno preuzimam sav rizik od bilo kakvih
povreda ili nesrećnih slučajeva ili smrti ukoliko se dese dok učestvujem u ovim aktivnostima.

2. Obavezujem se da ću opremu koju budem koristio prilikom vožnje kajaka, koristiti na

bezbjedan način, u skladu sa uputstvom koje sam dobio o korišćenju opreme, kako ne bih
ugrozio živote ljudi i imovine bilo kog pojedinca.

3. Da nijesam pod uticajem droge, alkohola ili drugih psihoaktivnih supstanci koje bi mogle
da utiču na pravilno rasuđivanje pri vožnji kajaka.

4. Da sam u dobrom zdravstvenom stanju i da kod mene ne postoji ni jedna zdravstvena

smetnja koja bi mogla uticati na vožnju kajaka.

5. Da sam blagovremeno upoznat sa svim opasnostima i rizicima koje mogu da nastanu

prilikom aktivnosti vožnje kajaka.

9. Da sam saglasan da sam dobio adekvatnu priliku da pročitam i razumijem tekst ove
Pristupnice, te da ista nije predočena u poslednjem trenutku.

11. Potvrđujem da sam saglasan/na kao roditelj ili zakonski staratelj da moje dijete ( Ime i
prezime________________________ JMBG:____________________ ), pristupi vožnji kajaka
i da doborovoljno preuzimam svu odgovornost i sav rizik koji može nastati meni ili mom
maloljetnom djetetu kao rezultat bilo kakve povrede.

12. Da sam pročitao ovu Pristupnicu i da sam u potpunosti razumio njegov sadržaj i pravne
posledice, te da pristajem na sve rizike i posledice predočene u ovoj Pristupnici i svojom
ozbiljnom i slobodnom voljom isti potpisujem kao znak prihvatanja iste.

Potpis: _____________________
 ACCEPTANCE OF RESPONSIBILITY FORM

I _________________________________________,with ID number:______________________,
adress______________________number_____ from ______________________ hereby declare:

1. That I understood that the activity of kayaking is an extreme sport, and that there is a risk
of injury and accidents. I expressly and voluntarily assume all risk of any injury or accident or
death that may occur while participating in these kayaking activities.

2. I undertake to use the equipment I will use while kayaking in a safe manner, in
accordance with the instructions I received on the use of the equipment, so as not to
endanger the lives of people and the property of any individual.

3. That I am not under the influence of drugs, alcohol or other psychoactive substances that
could affect proper judgment when driving a kayak.

4. That I am in good health and that I do not have any health problems that could affect
kayaking.

5. That I am familiar with all the dangers and risks that may arise during kayaking activities.

9. That I agree that I was given an adequate opportunity to read and understand the text of
this Application Form, and that it was not presented at the last moment.

11. I confirm that I agree as a parent or legal guardian for my child (Name and
Surname________________________ ID number:____________________ ), to go kayaking
and that I voluntarily assume all responsibility and all risk that may arise to me or my minor
child as a result of any injury .

12. That I have read this Application Form and that I fully understand its content and legal
consequences, and that I agree to all the risks and consequences presented in this
Application Form and sign it with my serious and free will as a sign of acceptance of it.

At Captain's Lake, date:________________ Signature:___________________