Be sure to complete your smart waiver ahead of time!

May 9, 2025

* Temporarily clogged ears are common after a skydive, but if you have a stuffed up head use caution! If you cannot breathe through your nose, the rapid pressure change of an extended freefall can result in extreme pain or even a broken eardrum.

AGREEMENT AND RELEASE OF LIABILITY

In consideration for being permitted to utilize the facilities and equipment of PA Skydive Center, Inc. and to engage in parachute jumping, ground instruction, flying and related activities hereinafter collectively referred to as “parachuting activities,” I certify I am at least 18 years of age and HEREBY AGREE AS FOLLOWS:

1) I understand and acknowledge that parachuting activities involve danger to me and can cause serious and fatal injuries and possibly infections.

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2) I hereby RELEASE AND DISCHARGE PA Skydive Center, Inc., pilots, instructors, coaches, helpers, owners of the aircraft, owners of land utilized for parachuting activities, United States Parachute Association and owners, manufacturers, distributors and dealers of skydive equipment. Hereinafter collectively referred to as the “Released Parties,” from any and all liability, claims, demands or causes of action that I may hereafter have for infections, injuries and damages arising from my participation in parachuting activities, INCLUDING BUT NOT LIMITED TO, LOSSES CAUSED BY THE NEGLIGENCE OF THE RELEASED PARTIES.

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2a) I understand that all coaches, instructors, videographers, parachute packers and riggers are independent contractors. I understand that I am personally selecting, hiring and separately paying them for any services rendered. I understand that all contractor fees were included in the quoted price and are not additional payments. I further understand that I may provide my own qualified United States Parachute Association rated, trained, and licensed contractor, provided they meet or exceed the minimum experience, currency and safety standards of the United States Parachute Association and the Uninsured United Parachute Technologies, LLC,. d/b/a UPT Vector.

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3) I further agree that I WILL NOT SUE OR MAKE A CLAIM against the Released Parties for damages or other losses sustained as a result of my participation in parachuting activities. I also agree to INDEMNIFY AND HOLD THE RELEASED PARTIES HARMLESS from all claims, judgments and costs, including attorney’s fees, incurred in connection with any action brought as a result of my participation in parachuting activities.

I Agree

4) I understand and acknowledge that parachuting activities have inherent danger that no amount of care, caution, instruction or expertise can eliminate, and I EXPRESSLY AND VOLUNTARILY ASSUME ALL RISK OF DEATH OR PERSONAL INJURY OR INFECTION SUSTAINED WHILE PARTICIPATING IN PARACHUTING ACTIVITIES WHETHER OR NOT CAUSED BY THE NEGLIGENCE OF THE RELEASED PARTIES.

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5) I have been advised and recognize that parachuting activities are not covered by any personal accident or general liability insurance policy issued to the Released Parties.

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6) CONTINUATION OF OBLIGATIONS. I agree and acknowledge that the terms and conditions of the foregoing agreement shall continue in force and effect now and in the future at all times during which I participate, either directly or indirectly, in parachuting activities, and shall be binding upon my heirs, executors, administrators, personal representatives, and/or anyone else claiming on my behalf.

I Agree

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May 9, 2025

Please select who will be participating...

Adult Minor(s)
1 Minor 2 Minors 3 Minors 4 Minors 5 Minors More Minors 6 Minors 7 Minors 8 Minors 9 Minors 10 Minors

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First Participant's Name

First Name*

Last Name*

Phone*

First Participant's Date of Birth*

First Participant's Information

Weight (lbs)? (Must be *

List any infirmities (infirmities are problems your instructor should know about while you are skydiving, i.e. - lack of hearing in one ear, so they can speak more toward the other). LEAVE IT BLANK if you have NO infirmities.

IMAGE RELEASE. I give the Released Parties permission to use any images, taken of me by their staff or assignees, for promotional purposes without compensation of further permission. Write "NO" IF YOU DO NOT AGREE with the image release. Leave it BLANK if you approve the image release.

First Participant's Signature*

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Second Participant's Name

First Name*

Last Name*

Second Participant's Date of Birth*

Second Participant's Information

Weight (lbs)? (Must be *

Third Participant's Name

First Name*

Last Name*

Third Participant's Date of Birth*

Third Participant's Information

Weight (lbs)? (Must be *

Fourth Participant's Name

First Name*

Last Name*

Fourth Participant's Date of Birth*

Fourth Participant's Information

Weight (lbs)? (Must be *

Fifth Participant's Name

First Name*

Last Name*

Fifth Participant's Date of Birth*

Fifth Participant's Information

Weight (lbs)? (Must be *

Sixth Participant's Name

First Name*

Last Name*

Sixth Participant's Date of Birth*

Sixth Participant's Information

Weight (lbs)? (Must be *

Seventh Participant's Name

First Name*

Last Name*

Seventh Participant's Date of Birth*

Seventh Participant's Information

Weight (lbs)? (Must be *

Eighth Participant's Name

First Name*

Last Name*

Eighth Participant's Date of Birth*

Eighth Participant's Information

Weight (lbs)? (Must be *

Ninth Participant's Name

First Name*

Last Name*

Ninth Participant's Date of Birth*

Ninth Participant's Information

Weight (lbs)? (Must be *

Tenth Participant's Name

First Name*

Last Name*

Tenth Participant's Date of Birth*

Tenth Participant's Information

Weight (lbs)? (Must be *

Parent or Guardian's Email Address

Email*

Confirm Email*

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Participant's Address

Address Line 1:*

Street address, P.O. box, company name, c/o

Address Line 2:

Apartment, suite, unit, building, floor, etc.

Country:*

City:*

State/Province:*

Zip/Postal:*

Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*

Parent(s) or Court-Appointed Legal Guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.

By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.

Parent or Guardian's Name

First Name*

Last Name*

Phone*

Parent or Guardian's Date of Birth*

Parent or Guardian's Information

Weight (lbs)? (Must be *

Parent or Guardian's Signature*

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