OŚWIADCZENIE

 

Imię i nazwisko (rodzica/opiekuna)...........................................................................................................

 

Oświadczam, że jako rodzic/opiekun prawny wyrażam zgodę na skorzystanie przez

n/w dzieci z parku linowego Siwa Polana, zapoznałe(a)m dzieci z treścią regulaminu i pouczyłe(a)m je co do konieczności jego przestrzegania.

 

1....................................................................................................................................................................

2....................................................................................................................................................................

3....................................................................................................................................................................

4....................................................................................................................................................................

5....................................................................................................................................................................

6....................................................................................................................................................................

7....................................................................................................................................................................

8....................................................................................................................................................................

9....................................................................................................................................................................

10..................................................................................................................................................................

11..................................................................................................................................................................

12..................................................................................................................................................................

13..................................................................................................................................................................

14..................................................................................................................................................................

15..................................................................................................................................................................

16..................................................................................................................................................................

17..................................................................................................................................................................

18..................................................................................................................................................................

19..................................................................................................................................................................

20..................................................................................................................................................................

21..................................................................................................................................................................

22..................................................................................................................................................................

23..................................................................................................................................................................

24..................................................................................................................................................................

25. ................................................................................................................................................................

26. ................................................................................................................................................................

27. ................................................................................................................................................................

28. ................................................................................................................................................................

29. ................................................................................................................................................................

30. ................................................................................................................................................................

 

Siwa Polana, data i podpis..........................................................................................................................

 

 

Dane osobowe służą wyłącznie do realizacji niniejszej usługi.