Loading...

MIDWEST FREEFALL SPORT PARACHUTE CLUB, INC.

 

CONTRACT OF AGREEMENT, RELEASE OF LIABILITY, ASSUMPTION OF RISK, AND AGREEMENT NOT TO SUE 

SKYDIVING AND PARACHUTING ARE INHERENTLY DANGEROUS ACTIVITIES!
YOUR PARTICIPATION IN THESE ACTIVITIES COULD CAUSE SERIOUS PERSONAL INJURY OR DEATH.
THIS AGREEMENT ABSOLVES MIDWEST FREEFALL SPORT PARACHUTE CLUB, INC., AND ALL OTHER RELEASED PARTIES OF ANY AND ALL RESPONSIBILITY WHATSOEVER FOR YOUR SAFETY.
 

In consideration of being permitted to use the facilities, services and/or equipment of MIDWEST FREEFALL SPORT PARACHUTE CLUB, INC. to engage in ground instruction, flying, freefall skydiving, parachute jumping, and any related activities, hereinafter collectively referred to as “skydiving and parachuting activities,” I indicate that I understand and accept the terms and conditions by signing my initials, selecting the "I Agree" checkboxes and/or affixing my signature to this document and HEREBY AGREE AS FOLLOWS:

  1. PARTIES INCLUDED. I understand that this Contract of Agreement, Release of Liability and Assumption of Risk includes the following individuals and entities, collectively referred to hereinafter as the Released Parties: Midwest Freefall Sport Parachute Club, Inc., Midwest Freefall, Inc., Midwest Air Services, Inc., Randall L. Allison, Wild Wind Skydivers, Inc., Pacific Aero LLC, Eagle Air Transport, Inc., MartinAire, Inc., and their agents, corporate officers and stockholders, employees, independent contractors, instructors, jumpmasters, pilots, aircraft owners, aircraft maintenance personnel, office personnel, parachute packers, parachute riggers, volunteers, and all other persons associated with the named persons and entities; Kunstman Management Group, LLC, the Henry Kunstman Airport, the owners of the airport, the airport managers, the airport officers, members of the airport board, its corporate officers, all airport stockholders, all airport personnel, all persons associated with the Kunstman airport and its ownership and/or operation and/or maintenance, owners of the airport land and buildings; Romeo State Airport, the owners of the airport, the airport managers, members of the airport board, its corporate officers, all airport stockholders, all persons associated with the airport and its ownership and/or operation and/or maintenance, owners of the airport land and buildings; Owners, lessors, and residents of all surrounding property where a skydiver may intentionally or inadvertently land; Ray Township, MI, Macomb County, MI, and their employees or agents; the Cessna Aircraft Company; the United States Parachute Association and its employees, agents, directors and members; and all manufacturers, distributors and dealers of skydiving equipment I, at any time, may use in my skydiving and parachuting activities as defined in Paragraph 2 below. This contract includes all persons and entities associated in any way with my skydiving and parachuting activities, whether in the air or on the ground.
  2. RISKS CONTEMPLATED. This Contract of Agreement is made in contemplation of all skydiving and parachuting activities, including but not limited to the following: ground-based instruction, training and practice; ground activities on and in the vicinity of the airport and/or parachute landing areas; ground transportation between airports and parachute landing areas; boarding and disembarking the aircraft on the ground, aircraft taxi operations, aircraft take-off and landing operations, flying in aircraft, any other aircraft-related activity; exiting the aircraft while in flight, freefall skydiving, tandem skydiving, parachute deployment, actions taken to address parachute malfunctions, parachute flying and steering, parachute landing, and any rescue operations or attempts by the Released Parties whether on, above, or off of any facilities used by or associated with the Released Parties.
  3. RELEASE FROM LIABILITY. I hereby release the Released Parties from any and all liability claims, demands or actions that I may have for any injuries, damages, and/or losses arising out of my participation in skydiving and parachuting activities even if caused by or attributable to negligence, gross negligence or other fault on the part of the Released Parties.
  4. COVENANT NOT TO SUE. I further agree that I WILL NOT SUE OR MAKE CLAIM OR INITIATE LEGAL ACTION against the Released Parties for injuries, damages and/or other losses sustained as a result of my participation in skydiving and parachuting activities even if caused by or attributable to negligence, gross negligence or other fault on the part of the Released Parties.
  5. INDEMNIFICATION AND HOLD HARMLESS. I also agree to indemnify and hold the Released Parties harmless from all claims, judgements and costs, including but not limited to attorney’s fees, and to pay for any expenses whatsoever incurred by the Released Parties in connection with any action brought by me as a result of my participation in skydiving and parachuting activities.
  6. ASSUMPTION OF RISK. I understand that skydiving and parachuting activities are inherently dangerous and I EXPRESSLY AND VOLUNTARILY ASSUME ALL RISK OF DEATH OR PERSONAL INJURY SUSTAINED WHILE PARTICIPATING IN SKYDIVING AND PARACHUTING ACTIVITIES WHETHER OR NOT CAUSED BY NEGLIGENCE, GROSS NEGLIGENCE OR OTHER FAULT OF THE RELEASED PARTIES, including but not limited to equipment malfunction from whatever cause, inadequate training, any deficiencies in the landing area, rescue attempts, bad landings, or any other injury I may sustain even if caused by negligence, gross negligence, or any other fault of the Released Parties.
  7. PARTIES BOUND BY THIS AGREEMENT.It is my understanding and intention that this Release and Agreement be binding not only on myself but on anyone or any entity, including my estate and heirs, that or who may be able to or does sue because of my injury or death. It is further my understanding and agreement that this Release is intended to and does release the Released Parties from any and all claims or obligations whatsoever arising in any way from my participation in skydiving and parachuting activities even if caused by negligence, gross negligence, or other fault.
  8. LIMITATIONS OF WARRANTY. Midwest Freefall Sport Parachute Club, Inc. hereby warrants that the equipment provided by Midwest Freefall Sport Parachute Club, Inc. or any other Released Party has been previously used and/or manufactured for skydiving and parachuting activities. This is the only warranty made and is made in lieu of any other warranties, expressed or implied, including but not limited to warranty of merchantability or fitness for a particular purpose. By initialing below, I acknowledge that I understand and accept this limitation of warranty.
  9. DURATION OF RELEASE. It is my understanding and intention that this Release and Agreement be effective not only for my first jump but for any subsequent jumps or activities in any way associated with the Released Parties.
  10. ENFORCEABILITY. I agree that if any portions of the Release and Agreement are found to be unenforceable or against public policy, that only that portion shall fail. In addition, I specifically waive any unenforceability or any public policy argument that I may make or that may be made on behalf of my estate or by anyone who would sue or bring legal action because of my injury or death.
  11. INSURANCE COVERAGE STATEMENT. I hereby certify that I have adequate insurance coverage (both medical and life) to cover any eventuality arising from my participation in skydiving and parachuting activities, or that my current level of insurance (medical and/or life) may be inadequate to cover any eventuality arising from my participation in skydiving and parachuting activities. I elect to participate in skydiving and parachuting activities with my current level of coverage regardless of what those coverages may be.
    I Agree
  12. EMERGENCY MEDICAL SERVICES. In the event I sustain any significant injuries while participating in skydiving and parachuting activities, Midwest Freefall Sport Parachute Club, Inc. will call for emergency medical personnel for transportation to a medical treatment facility and this will be at my own expense.
    I Agree
  13. DRUG AND ALCOHOL USE. I hereby certify that I have not consumed, and will not consume, any alcoholic beverages or illegal drugs within the 8 hours preceding my participation in skydiving and parachuting activities. I understand that it is a violation of numerous rules and regulations to consume alcohol and/or illegal drugs while engaging in skydiving and parachuting activities and agree to refrain from doing so.
    I Agree
  14. MEDICAL STATEMENT. I hereby certify that I am afflicted with no physical or mental infirmity, and am not under any treatment for any physical or mental infirmity, ailment or injury of any nature that would adversely affect my ability to participate in skydiving and parachuting activities. I further certify that I am not taking any medication that would adversely affect my ability to participate in skydiving and parachuting activities. Examples of conditions that may adversely affect a person’s ability to participate in skydiving and parachuting activities include cardiac and pulmonary disease, seizures, convulsions, shortness of breath, mental illness, nervous disorders, hearing or sight problems, back or spinal problems, depression, fainting spells, dizziness, pregnancy, broken bones or sprains, anxiety, etc.

    I will consult with a medical professional of my choice if I have any questions regarding any medical conditions that may affect my fitness for participation in skydiving and parachuting activities. I understand that Midwest Freefall Sport Parachute Club, Inc. cannot make a medical determination, but can request a medical assessment by a doctor prior allowing participation in skydiving and parachuting activities.
    I Agree
  15. HARNESS FITTING PROCEDURES. I understand that it is necessary for me to be suited with a harness/container system when making an Accelerated Freefall (AFF) skydive, or a harness which will allow me to be hooked to my instructor’s harness when making a Tandem skydive. I further understand that, for safety reasons, it is imperative that this harness fit snugly about my body and it may be necessary for my instructor or other staff to touch me in places I find personal or offensive in order to ensure the security of this harness system. I further understand that the harness, when attached to the instructor during an actual Tandem skydive, places my body in close proximity to that of my instructor. By initialing below this paragraph, I acknowledge that I understand the procedure of fitting me with an AFF or Tandem harness system and waive any claim which I might have against any of the Released Parties by reason of the same.
    I Agree
  16. COMPETENCY. I hereby certify and affirm that I am not now nor ever have been adjudicated incompetent in any court and further there is no guardian or person appointed by any court whose consent is required as a precondition of my knowing and willing waiver as herein provided. I am over the age of 18 and am not presently functioning under any legal, mental or physical incapacity. 
    I Agree
  17. LEGAL RIGHTS. I fully understand that by signing this document I AM GIVING UP IMPORTANT LEGAL RIGHTS. IT IS MY INTENTION TO DO SO.
    I Agree
  18. UNDERSTANDING OF AGREEMENT. I understand that I may consult with an attorney of my choosing before entering into any agreement with Midwest Freefall Sport Parachute Club, Inc. Midwest Freefall Sport Parachute Club, Inc. will provide upon my request a list of other companies providing like or similar services. I hereby certify that I have read and understand the contents of this document and wish to be bound by its items, terms and conditions.
    I Agree
  19. I DO NOT HAVE TO SKYDIVE. I understand that I do not have to skydive and can change my mind at any time prior to placing my body outside of the aircraft exit door and choose not to jump.
    I Agree

I HAVE CAREFULLY READ THIS CONTRACT OF AGREEMENT, RELEASE OF LIABILITY, ASSUMPTION OF RISK AND AGREEMENT NOT TO SUE DOCUMENT. I FULLY UNDERSTAND ITS CONTENTS AND SIGN IT OF MY OWN FREE WILL.

I HEREBY CERTIFY AND WARRANT THAT THE STATEMENTS CONTAINED ABOVE ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF. I FURTHER CERTIFY AND UNDERSTAND THAT ACCEPTANCE OF THIS AGREEMENT BY MIDWEST FREEFALL SPORT PARACHUTE CLUB, INC. WILL BE MADE ON THE BASIS OF THE STATEMENTS CONTAINED ABOVE, AND SUCH ACCEPTED TERMS AND CONDITIONS BECOME PART OF THIS AGREEMENT BETWEEN MYSELF AND MIDWEST FREEFALL SPORT PARACHUTE CLUB, INC. TO PROVIDE ANY SERVICES.

 
Date: April 26, 2019 

MIDWEST FREEFALL SPORT PARACHUTE CLUB, INC.
CLUB POLICY & JUMP PRICING AGREEMENT

MISSION STATEMENT:

Midwest Freefall Sport Parachute Club (SPC), Inc. is a Michigan Non-Profit entity that exists solely for the promotion and enjoyment of Skydiving and Sport Parachuting. The Club's Mission Statement is as follows:

"To develop and promote our membership's interests in the sport of Skydiving; to promote and maintain the highest standards of safety and training in the skydiving industry; to communicate and raise the public consciousness of the safe and responsible nature of skydiving as a sport and recreational activity; and to utilize and embrace the ethical standards and operational procedures established by the United States Parachute Association as affirmed by the USPA Group Member Pledge."

WHY DOES MIDWEST FREEFALL SPC EXIST?

Midwest Freefall Sport Parachute Club exists as a dedicated group of jumpers who enjoy having the privilege of jumping at our outstanding facility in Ray Township, Michigan, close to metropolitan Detroit, in a rural, private setting.  We have worked hard to establish what we believe is the most comfortable, inviting place to skydive in Michigan and are proud of our club facilities

DO YOU HAVE TO BE A MEMBER TO JUMP?

You do not have to be a member to make a first jump at Midwest Freefall SPC. Your first Tandem, AFF or Fun jump can be made as a guest. Club membership is required of persons making more than one skydive at Midwest.

HOW DOES A PERSON JOIN THE CLUB?

Signing this document and paying the appropriate dues amount as a surcharge of one dollar on each lift ticket makes you a member of the club. The primary tangible benefit of club membership is the ability to jump at the dropzone. Other benefits include the ability to participate in club social events and periodic club meetings.

AGREEMENT TO ABIDE BY CLUB MEMBERSHIP RULES

By affixing my initials to the line below, I agree to the conditions stated above.

 

All Jumpers, including licensed skydivers, must complete the following section

 

Uninsured United Parachute Technologies, LLC 

TANDEM PARACHUTE JUMPER AGREEMENT

This is an important legal document. Allow yourself sufficient time to carefully read and understand the entire document, because by signing it, you are agreeing to give up certain legal rights.

In consideration of the Uninsured United Parachute Technologies, LLC, doing business as UPT Vector, and Midwest Freefall Sport Parachute Club, Inc., hereinafter referred to as "Corporation", allowing me the privilege of utilizing a dual-harness, dual container parachute pack assembly (also known as a "tandem parachute system"), designed, manufactured and/or assembled by the Uninsured United Parachute Technologies, LLC, d/b/a UPT Vector, for the purpose of performing an intentional parachute jump, I agree that:

1) Representations, Warranties, & Assumptions of Risk: I understand that parachute jumping will expose me to the risk of personal injury, property damage and/or death. I understand that the success of my jump is dependent upon the perfect functioning of the airplane from which I intend to jump and the parachute system, and that neither the airplane nor the parachute system can be guaranteed to function perfectly. I understand that the airplane and the parachute system are both subject to mechanical malfunctions as well as operator error. I freely, voluntarily and expressly choose to assume all risks inherent in parachute jumping, including, but not limited to, risks of equipment malfunction and/or failure to function, including those which may result from some defect in design, assembly, and/or manufacture as well as those risks arising from improper and/or negligent operation and/or use of the equipment, for and in consideration of the thrill of participation in this activity, understanding full well that those risks may include personal injury, property damage, and/or death.

I Agree

2) Exemption and Release from Liability: I exempt and release the following persons and organizations:

I Agree

(A) The Corporations and their officers, directors, agents, servants, employees, shareholders, and other representatives;

I Agree

(B) Manufacturers, designers, and suppliers of component equipment incorporated in the dual-harness, dual-container parachute pack assembly to which I will be attached during my intentional parachute jump;

I Agree

(C) Owners, suppliers, and operators of aircraft from which I am to make my intentional parachute jump;

I Agree

(D) The owner of the dual-harness, dual-container parachute pack assembly, and any of its components, to which I will be attached during my intentional parachute jump;

I Agree

(E) The operator ("parachutist in command") of the dual-harness, dual-container parachute pack assembly to which I will be attached during my intentional parachute jump;

I Agree

(F) If I am making my intentional parachute jump at or near a parachuting/skydiving facility, the owners and operators of that facility, as well as their officers, directors, agents, servants, employees, shareholders, and other representatives;

I Agree

(G) The owners and lessees, if any, of land upon and from which the parachute jumping and related aircraft operations are conducted; and

I Agree

(H) The Toll-Free Skydiving Network, Inc., Uninsured (800) Skydive Leasing Corp., Uninsured (888) Skydive Leasing Corp., Uninsured (877) Skydive Leasing Corp., 1-800 FREEFALL, and any and all other skydiving referral service business entities, and/or owners of fictitious name entities which I may have used in locating and/or deciding upon a parachuting/skydiving facility or other location at which to perform an intentional parachute jump.

I Agree

(I) Any other person and/or organization which is or may be liable for any loss or injury to me and or my property, or my death, arising out of my participation in any of the activities covered by this Agreement (as defined below);

I Agree

From any and all liability, claims, demands or actions or causes of action whatsoever arising out of any damage, loss or injury to me or my property, or my death, whether occurring while I am training and/or preparing for my intentional parachute jump, while I am present in aircraft from which the jump is to be made, while I am making my intentional parachute jump, or while I am engaged in related activities (hereafter referred to as "activities covered by this Agreement"), whether such loss, damage, injury, or death results from the negligence and/or other fault, either active or passive of any of the persons and/or organizations described in paragraphs 2(A)-(I) above, or from any other cause.

I Agree

3) Covenant Not to Sue: I agree never to institute any suit or action at law or otherwise against any of the organizations and/ or persons described in paragraph 2(A) through (I) above, or to initiate or assist in the prosecution of any claim for damages or cause of action which I may have by reason of injury to my person or property, or my death, arising from the activities covered by this Agreement, whether caused by the negligence and/or fault, either active or passive, of any of the organizations and/or persons described in paragraph 2(A) through (I) above, or from any other cause. I further expressly agree that I will never raise any claim against any of the organizations and/or persons described in paragraph 2(A) through (I) above for product liability, failure to warn, negligence, breach of warranty, breach of contract, or strict liability, regardless of whether my claims for damages or injuries are alleged to result from the fault or negligence of the parties released. I further agree that my heirs, executors, administrators, personal representatives, and/or anyone else claiming on my behalf, shall not institute any suit or action at law or otherwise against any of the organizations and/or persons described in paragraph 2(A) through (I) above, nor shall they initiate or assist the prosecution of any claim for damages of cause of action which I, my heirs, executors, administrators, personal representatives, and/or anyone else claiming on my behalf may have by reason of injury to my person or property, or my death arises from the activities covered by this Agreement, whether caused by the negligence and/or fault, either active or passive, of any of the organizations and/or persons described in paragraph 2(A) through (I) above, or from any other cause, I hereby so instruct my heirs, executors, administrators, personal representatives, and/or anyone else claiming on my behalf. Should any suit or action at law or otherwise be instituted in violation of this Agreement against any of the organizations and/or persons described in paragraph 2(A) through (I) above, I agree that such organizations and/or persons shall be entitled to recover, in addition to any other damages which may be incurred, reasonable attorneys' fees and costs incurred in defense of such suit or action, including any appeals therefrom. 

I Agree

4) Indemnity Against Claims: I will indemnify, defend, save and hold harmless the organizations and/or persons described in paragraph 2(A) through (I) above from any and all losses, claims, actions or proceedings of every kind and character, including attorneys' fees and expenses, which may be presented or initiated by any persons and/or organizations and which arise directly or indirectly from my participation in the activities covered by the Agreement, whether resulting from the negligence and/or other fault, either active or passive, or any of the organizations and/or persons described in paragraph 2(A) through (I) above, or from any other cause.

I Agree

5) Validity of Waiver: I understand that if I institute or anyone on my behalf institutes, any suit or action at law or any claim for damages or cause of action against any of the organizations and/or persons described in paragraph 2(A) through (I) above because of injury to my person or property, or my death, due to the activities covered by this Agreement, this Agreement can and will be used in court, and that such agreements have been upheld in courts in similar circumstances.

I Agree

6) Representations and Warranties as to Medical Condition: I represent and warrant that (a) I have no physical infirmity, except those listed below, am not under treatment for any other physical infirmity or chronic ailment or injury of any nature, and have never been treated for any other of the following: cardiac or pulmonary conditions or diseases, diabetes, fainting spells or convulsions, nervous disorder, kidney or related diseases, high or low blood pressure; (b) I am not under any medication of any kind at the present time; and (c) If I am prescribed corrective lenses, I agree to wear them during my intentional parachute jump.

I Agree

7) Waiver of Jury Trial/Applicable Law/Venue/Headings: I agree that the law of the State of Florida shall apply to issues involving the construction, interpretation, and validity of this Agreement, and that Florida law shall govern any dispute between the parties arising from the activities covered by this Agreement. In the event this Agreement is violated and suit is brought against any of the organizations and/or persons described in paragraph 2(A) through (I) above, I waive my right to a jury trial, and agree that Volusia County, Florida shall be the sole venue for any suit or action arising from the activities covered by this Agreement. I agree that the headings and sub-headings used throughout this Agreement are for convenience only and have no significance in the interpretation of the body of this Agreement.

I Agree

8) Severability/Multiple Waivers: I agree that should one or more provisions in this Agreement be judicially determined to be unenforceable, the remaining provisions shall continue to be binding and enforceable against me. If I have executed any other agreement containing provisions relating to the exemption and/or release from liability and/or covenant not to sue in connection with the activities covered by this Agreement, I agree that the agreement which provides the most protection from liability and/or suit to the Uninsured United Parachute Technologies, LLC, d/b/a UPT Vector shall be enforceable against me by the Uninsured United Parachute Technologies, LLC,. d/b/a UPT Vector.

I Agree

9) Continuation of Obligations: I agree and acknowledge that the terms and conditions of this Agreement shall continue in force and effect now and in the future at all times during which I participate in the activities covered by this Agreement, and shall be binding upon my heirs, executors, administrators, personal representatives, and/or anyone else claiming on my behalf. This Agreement supersedes and replaces any prior such agreement I have signed.

I Agree

10) Viewing of Videotape: I have viewed and I warrant that I fully understand the accompanying "Tandem Vector Waiver" video tape.

I Agree

I freely and voluntarily agree to all of the above by signing this contract on the day of April 26, 2019. 

*Please read each paragraph carefully. Your initial indicates you understand and agree to all of the information and terms contained therein.

First Jumper's Name

First Name*

Last Name*

Phone*
First Jumper's Date of Birth*
First Jumper's Information

Height: *

Weight: *

How did you hear about Midwest Freefall?

List infirmities - if none, please state "none" *
First Jumper's Signature*
Second Jumper's Name

First Name*

Last Name*
Second Jumper's Date of Birth*
Second Jumper's Information

Height: *

Weight: *

How did you hear about Midwest Freefall?

List infirmities - if none, please state "none" *
Third Jumper's Name

First Name*

Last Name*
Third Jumper's Date of Birth*
Third Jumper's Information

Height: *

Weight: *

How did you hear about Midwest Freefall?

List infirmities - if none, please state "none" *
Fourth Jumper's Name

First Name*

Last Name*
Fourth Jumper's Date of Birth*
Fourth Jumper's Information

Height: *

Weight: *

How did you hear about Midwest Freefall?

List infirmities - if none, please state "none" *
Fifth Jumper's Name

First Name*

Last Name*
Fifth Jumper's Date of Birth*
Fifth Jumper's Information

Height: *

Weight: *

How did you hear about Midwest Freefall?

List infirmities - if none, please state "none" *
Sixth Jumper's Name

First Name*

Last Name*
Sixth Jumper's Date of Birth*
Sixth Jumper's Information

Height: *

Weight: *

How did you hear about Midwest Freefall?

List infirmities - if none, please state "none" *
Seventh Jumper's Name

First Name*

Last Name*
Seventh Jumper's Date of Birth*
Seventh Jumper's Information

Height: *

Weight: *

How did you hear about Midwest Freefall?

List infirmities - if none, please state "none" *
Eighth Jumper's Name

First Name*

Last Name*
Eighth Jumper's Date of Birth*
Eighth Jumper's Information

Height: *

Weight: *

How did you hear about Midwest Freefall?

List infirmities - if none, please state "none" *
Ninth Jumper's Name

First Name*

Last Name*
Ninth Jumper's Date of Birth*
Ninth Jumper's Information

Height: *

Weight: *

How did you hear about Midwest Freefall?

List infirmities - if none, please state "none" *
Tenth Jumper's Name

First Name*

Last Name*
Tenth Jumper's Date of Birth*
Tenth Jumper's Information

Height: *

Weight: *

How did you hear about Midwest Freefall?

List infirmities - if none, please state "none" *
Jumper'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:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Emergency Contact

Emergency Contact (please list someone not in your skydiving party):


Name: *

Phone: *
Licensed Skydivers Only - First time jumpers and students please leave this section blank.

USPA Membership Number

USPA Expiration Date

USPA License Number

Total Number of Jumps
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.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

Height: *

Weight: *

How did you hear about Midwest Freefall?

List infirmities - if none, please state "none" *
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver