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BAY AREA SKYDIVING INC.

THIS IS AN IMPORTANT DOCUMENT-READ CAREFULLY

WARNING!!!!  By signing this legal document you are giving up important legal rights.  You will probably not be able to win a lawsuit, even though your injury(s) is the fault of someone other than yourself.  Do not sign this document until you have thought about the consequences.  Discuss these consequences with whom ever you desire.

NOTICE:          If you do not want to sign this document we will be glad to furnish you a list of other skydiving centers where you can go for training and/or jumping.

NOTICE:          There is an accident report file available for your inspection.  These reports detail some of the accidents and injuries that have occurred in skydiving.

INSURANCE:    Your skydiving activities are not covered by any insurance policy.  If you require insurance you must furnish your own through your insurance carrier.

WARNING:       Skydiving and all associated activities are HIGH RISK.  They include the risk of sprains, breaks, serious injury and risk of death.


I HAVE READ AND UNDERSTAND THE ABOVE 5 PARAGRAPHS.

                                                                                                      

In consideration for being allowed to utilize the facilities and equipment of BAY AREA SKYDIVING INC. and to engage in INSTRUCTION, GROUND TRAINING, FLYING, SKYDIVING and any and all related activities (here-in-after referred to, collectively, as skydiving activities)

I hereby agree as follows:

NOTE:    Read and understand each provision of this agreement and so indicate by placing an X in the space provided at the end of each important item or paragraph.
RELEASE OF LIABILITY, INDEMNITY, AGREEMENT, ASSUMPTION OF RISK, CONVENANT NOT TO SUE, HOLD HARMLESS AGREEMENT, CONTINUATION OF OBLIGATION AND WAIVER OF RIGHTS.

1. I hereby forever RELEASE AND DISCHARGE, BAY AREA SKYDIVING INC., WEST COAST AIR SPORTS, INC, Airspeed Aviation, LLC, CONTRA COSTA COUNTIES, UNITED STATES PARACHUTE ASSOCIATION, SHAUN FENNER, Manufacturers, Distributors and Dealers of Skydiving equipment, land owners, aircraft owners, instructors, concessionaires, contractors, pilots, officers, agents, employees, staff, representatives of any of the above named parties and other parties as may be named by BAY AREA SKYDIVING INC.(here-in-after referred to as ‘the released parties’), from any and all liability, claims, or causes of action what-so-ever, arising out of any damage, loss or injury to me or my property while participating in skydiving activities, including, but not limited to, losses CAUSED BY THE PASSIVE OR ACTIVE NEGLIGENCE OF THE RELEASED PARTIES OR HIDDEN, LATENT OR OBVIOUS DEFECTS in the equipment used or in/on any part of the premises.

I Agree

2.  I further agree the I WILL NOT SUE OR MAKE A CLAIM against the released parties for loss or damage sustained as a result of my participation in skydiving activities. I also agree to INDEMNIFY  AND HOLD-HARMLESS the released parties from all CLAIMS, JUDGMENTS AND COSTS, INCLUDING ATTORNEY’S FEES, incurred in connection with any action brought as a result of my participation in skydiving activities.  I hereby instruct my heirs, executors and administrators never to institute any suit or action at law against any of the released parties, even if losses are caused by the PASSIVE OR ACTIVE NEGLIGENCE OF ANY OR ALL RELEASED PARTIES OR OBVIOUS OR HIDDEN DEFECTS OF THE PREMISES, EQUIPMENT OR AIRCRAFT USED. I acknowledge and agree that this agreement shall remain in full force and effect now and in the future. This agreement shall be binding upon my heirs, executors and administrators of my estate. THE INTENT OF THIS RELEASE AND DISCHARGE IS TO REMOVE ANY DUTY OF CARE TO ME BY THE RELEASED PARTIES, WHAT-SO-EVER.

I Agree

3.  I understand and acknowledge that skydiving activities have inherent dangers that no amount of care, caution, instruction or expertise can eliminate.  I EXPRESSLY AND VOLUNTARILY ASSUME ALL RISKS associated with skydiving activities.  I am fully aware that skydiving activities include the possibility of SERIOUS INJURY AND/OR DEATH.  Knowing this I ASSUME ALL RISKS OF INJURY OR DEATH, even though there my be PASSIVE OR ACTIVE NEGLIGENCE, HIDDEN, LATENT OR OBVIOUS DEFECTS in or on the premises, equipment or aircraft disclaimers. 

I Agree
   

4.  I understand that the parachutes and associated equipment I will use are provided without warranty.  They are expressly not warranted that they are fit for a particular purpose, what-so-ever.  PARACHUTES DO NOT ALWAYS WORK THE WAY THEY ARE EXPECTED OR INTENDED.  Furthermore, I understand my body position and stability can drastically effect the deployment and operation of the parachute.  I accept these disclaimers.

I Agree

5.  I understand that the nature of skydiving makes it impossible for an instructor to determine, with any degree of certainty, that I have been trained properly and adequately or that I have grasped and comprehend the instruction given to me. Furthermore, it is impossible for an instructor to predict how I will react under the high speed conditions and stress that are inherent in skydiving activities. I understand that there is no warranty, expressed or implied, what-so-ever, as to the adequacy of the training provided to me. I understand that if I am not sure of any part of the training I can return and re-train with any scheduled class at no additional cost to me. Furthermore, I understand that I will be required to warrant that based on my own evaluation and understanding of training I have received that I can safely perform a skydive and cope with high speed stress conditions and stress, before I will be allowed to skydive.

I Agree

6.  I specifically agree that I have been afforded the opportunity to inspect all of the aircraft and facilities provided by BAY AREA SKYDIVING INC. and their concessionaires. I acknowledge the landing area does contain such dangerous objects as trees, fences, power lines, hills, canals, buildings, rocks, holes, uneven terrain, clods, unpredictable wind conditions and other natural and man-made objects that can cause injury to me upon landing. Furthermore, I understand the landing area is in the vicinity of an active aircraft taxi-way and runway and if I land on or near aircraft that are running, taxing, landing or taking off.  I risk the high probability of injury or death upon landing. Even under the best circumstances landing can be an extremely dangerous activity in which many injuries occur. 

I Agree
   Based upon my independent evaluation of the risks involved.  I REAFFIRM MY ASSUMPTION OF RISKS AND DANGERS OUTLINED IN THIS DOCUMENT.
I Agree
         

7.  As part of the consideration for my being allowed to utilize the facilities of BAY AREA SKYDIVING INC. and participate in skydiving activities, I HAVE PROMISED NOT TO SUE ANY OF THE RELEASED PARTIES for any cause of action what-so-ever.  Furthermore, I realize that the damages to the released parties, if I should decide to breach this promise, are uncertain and difficult to establish.  Therefore, in the event I breach this promise I agree the LIQUIDATED DAMAGES I WILL BE LIABLE TO PAY EACH OF THE PARTIES, NAMED IN ANY LAWSUIT I MAY BRING, IS $25,000.00.  I further agree that this provision for liquidated damages shall apply to any action in which I am required to indemnify the released parties and it will be addition to any award made to the third party in each suit.

I Agree
 

8.  I certify that I have made adequate provision for those persons dependent upon me and my heirs, if any, so that in the event of my injury or death they will have suffered no financial loss.

I Agree

9.  It is specifically agreed that venue and jurisdiction for any legal action arising out of any matter, which is the subject of this document, shall be in Superior Court of the State of California, county of Contra Costa.

I Agree

10.  If the court should decide that any clause in this contract is unenforceable or illegal, such determination shall not effect the validity of the remaining provisions, all of which shall remain in full force and effect.

I Agree

11.  I hereby certify that I do not suffer from any physical infirmity, previous injury or chronic illness that could effect my ability to safely engage in skydiving activities. IIf there is any question how an injury, illness or medications might effect your ability to safely engage in skydiving activities you must check with your doctor and bring a signed statement that in the opinion of your doctor it is safe for you to participate in the sport.  FURTHER, I CERTIFY I HAVE NOT CONSUMED ALCOHOL AND/OR DRUGS WHILE ENGAGING IN SKYDIVING ACTIVITIES.  Warning:  During the opening sequence of the canopy you decelerate from 120 mph to 10 mph in approximately 2 seconds.  If you have skeletal problems, please check with your doctor as to the safety of your participation in this activity.

I Agree

12.  SUMMARY:  I recognize this agreement is a contract pursuant to which I have released any and all parties from liability for any loss, either to my person or property, EVEN IF SUCH LOSS IS RESULT OF NEGLIGENCE, EITHER PASSIVE OR ACTIVE of any of the released parties, singly or collectively.  Further, if I institute a lawsuit or action at law against any or all of the released parties the LIQUIDATED DAMAGES I AM LIABLE FOR IS $25,000.00 FOR EACH DEFENDANT.  This document will be used in court in the event of a lawsuit.  I UNDERSTAND AGREEMENTS OF THIS TYPE HAVE BEEN UPHELD IN COURTS IN SIMILAR CIRCUMSTANCES.

I Agree

I HAVE CAREFULLY READ THIS CONTRACT AND RELEASE OF LIABILITY.  I FULLY UNDERSTAND ITS CONTENTS AND SIGN IT OF MY OWN FREE WILL.  I CERTIFY THAT I AM 18 YEARS OR OLDER.

I Agree
 

I UNDERSTAND THAT I AM NOT GUARANTEED TO TRAIN AND SKYDIVE THE SAME DAY.

I Agree


Date: October 16, 2021

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 BAY AREA SKYDIVING, 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:

I Agree

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 an/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 dualharness, 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 an/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 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 understand, Bay Area Skydiving has a strict No Refunds policy and ALL Sales are final.

I Agree

I understand, Skydiving is Weather Dependent and should weather prevent my Skydive from taking place, I understand I will be afforded the opportunity to reschedule for a later date.

I Agree

I freely and voluntarily agree to all of the above by signing this contract on the day of October 16, 2021 at BYRON, CA.

*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

I am under treatment for (If NONE, WRITE NONE): *

And/or taking medication for (IF NONE, WRITE NONE): *
Bay area skydiving may use any of your photos or videos for promotional purposes. *
I Agree

I CERTIFY THAT I DO NOT WEIGH MORE THAN (POUNDS): *
Corrective Lenses*

List infirmities, if not, state "none" *

Where did you hear about us?

Preferred Name (Nickname):

WEIGHT (lbs): *
First Jumper's Signature*
Second Jumper's Name

First Name*

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

I am under treatment for (If NONE, WRITE NONE): *

And/or taking medication for (IF NONE, WRITE NONE): *
Bay area skydiving may use any of your photos or videos for promotional purposes. *
I Agree

I CERTIFY THAT I DO NOT WEIGH MORE THAN (POUNDS): *
Corrective Lenses*

List infirmities, if not, state "none" *

Where did you hear about us?

Preferred Name (Nickname):

WEIGHT (lbs): *
Third Jumper's Name

First Name*

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

I am under treatment for (If NONE, WRITE NONE): *

And/or taking medication for (IF NONE, WRITE NONE): *
Bay area skydiving may use any of your photos or videos for promotional purposes. *
I Agree

I CERTIFY THAT I DO NOT WEIGH MORE THAN (POUNDS): *
Corrective Lenses*

List infirmities, if not, state "none" *

Where did you hear about us?

Preferred Name (Nickname):

WEIGHT (lbs): *
Fourth Jumper's Name

First Name*

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

I am under treatment for (If NONE, WRITE NONE): *

And/or taking medication for (IF NONE, WRITE NONE): *
Bay area skydiving may use any of your photos or videos for promotional purposes. *
I Agree

I CERTIFY THAT I DO NOT WEIGH MORE THAN (POUNDS): *
Corrective Lenses*

List infirmities, if not, state "none" *

Where did you hear about us?

Preferred Name (Nickname):

WEIGHT (lbs): *
Fifth Jumper's Name

First Name*

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

I am under treatment for (If NONE, WRITE NONE): *

And/or taking medication for (IF NONE, WRITE NONE): *
Bay area skydiving may use any of your photos or videos for promotional purposes. *
I Agree

I CERTIFY THAT I DO NOT WEIGH MORE THAN (POUNDS): *
Corrective Lenses*

List infirmities, if not, state "none" *

Where did you hear about us?

Preferred Name (Nickname):

WEIGHT (lbs): *
Sixth Jumper's Name

First Name*

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

I am under treatment for (If NONE, WRITE NONE): *

And/or taking medication for (IF NONE, WRITE NONE): *
Bay area skydiving may use any of your photos or videos for promotional purposes. *
I Agree

I CERTIFY THAT I DO NOT WEIGH MORE THAN (POUNDS): *
Corrective Lenses*

List infirmities, if not, state "none" *

Where did you hear about us?

Preferred Name (Nickname):

WEIGHT (lbs): *
Seventh Jumper's Name

First Name*

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

I am under treatment for (If NONE, WRITE NONE): *

And/or taking medication for (IF NONE, WRITE NONE): *
Bay area skydiving may use any of your photos or videos for promotional purposes. *
I Agree

I CERTIFY THAT I DO NOT WEIGH MORE THAN (POUNDS): *
Corrective Lenses*

List infirmities, if not, state "none" *

Where did you hear about us?

Preferred Name (Nickname):

WEIGHT (lbs): *
Eighth Jumper's Name

First Name*

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

I am under treatment for (If NONE, WRITE NONE): *

And/or taking medication for (IF NONE, WRITE NONE): *
Bay area skydiving may use any of your photos or videos for promotional purposes. *
I Agree

I CERTIFY THAT I DO NOT WEIGH MORE THAN (POUNDS): *
Corrective Lenses*

List infirmities, if not, state "none" *

Where did you hear about us?

Preferred Name (Nickname):

WEIGHT (lbs): *
Ninth Jumper's Name

First Name*

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

I am under treatment for (If NONE, WRITE NONE): *

And/or taking medication for (IF NONE, WRITE NONE): *
Bay area skydiving may use any of your photos or videos for promotional purposes. *
I Agree

I CERTIFY THAT I DO NOT WEIGH MORE THAN (POUNDS): *
Corrective Lenses*

List infirmities, if not, state "none" *

Where did you hear about us?

Preferred Name (Nickname):

WEIGHT (lbs): *
Tenth Jumper's Name

First Name*

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

I am under treatment for (If NONE, WRITE NONE): *

And/or taking medication for (IF NONE, WRITE NONE): *
Bay area skydiving may use any of your photos or videos for promotional purposes. *
I Agree

I CERTIFY THAT I DO NOT WEIGH MORE THAN (POUNDS): *
Corrective Lenses*

List infirmities, if not, state "none" *

Where did you hear about us?

Preferred Name (Nickname):

WEIGHT (lbs): *
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*
Parent or Guardian's Driver's License / ID Card

Driver's License / ID Card Number*

Issuing State*
EMERGENCY CONTACT INFORMATION:

Name: *

Relationship: *

Primary Phone # *
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

I am under treatment for (If NONE, WRITE NONE): *

And/or taking medication for (IF NONE, WRITE NONE): *
Bay area skydiving may use any of your photos or videos for promotional purposes. *
I Agree

I CERTIFY THAT I DO NOT WEIGH MORE THAN (POUNDS): *
Corrective Lenses*

List infirmities, if not, state "none" *

Where did you hear about us?

Preferred Name (Nickname):

WEIGHT (lbs): *
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.


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