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ASSUMPTION OF RISK, RELEASE OF LIABILITY & WAIVER OF CLAIMS AGREEMENT

ASSUMPTION OF RISK, RELEASE OF LIABILITY & WAIVER OF CLAIMS AGREEMENT

In consideration for being allowed to use the facilities, aircraft, and equipment provided by Way Up Skydiving LLC dba Skydive Danielson (“Way Up”), Relative Workshop, 82 Bravo LLC, Danielson Airport, New England Flight Services LLC, New England Aero Services Inc., the State of Connecticut, CT Airport Authority, the United States Parachute Association (“USPA”), and manufacturers, distributors and dealers of skydiving equipment (collectively referred to herein as the “Released Parties”) and to participate in skydiving, parachuting, and all related activities, which include but are not limited to, ground and air transportation, training, parachute packing and rigging, aviation, observing, and all related activities (collectively the “Activities”) provided by any and/or all of the Released Parties, the Participant hereby agrees, to the fullest extent permitted by law, as follows:

a) TO WAIVE ALL CLAIMS that Participant has or may have against the Released Parties, and/or their respective owners, affiliates, employees, and/or agents arising out of the inherent risks of participating in the Activities, which inherent risks include, but are not limited to, airplane crash, equipment failure or malfunction, weather and wind, collisions, landing, and/or the decision-making of Participant, other participants, and/or any employees or agents of the Released Parties;

b) TO ASSUME ALL RISKS INHERENT IN PARTICIPATING IN THE ACTIVITIES. Participant understands and agrees that SKYDIVING AND PARACHUTING ARE ULTRA–HAZARDOUS, and Participant expressly assumes all risk of injury and/or death arising from, and/or related to, the inherent risks of the Activities, including but not limited to those set forth above in Section (a); and

c) TO RELEASE the Released Parties, and their respective owners, affiliates, employees, and/or agents, from all liability for any loss, damage, injury, or expense that the Participant [and/or his/her next of kin] may suffer, arising out of the inherent risks of participation in the Activities, including but not limited to those set forth above in Section (a).

d) Participant hereby grants to Way Up, its representatives and employees the right to take photographs and video of Participant in connection with Participant’s participation in the Activities. Participant hereby authorizes Way Up to copyright, use, and publish the same in print and/or electronic form. Participant hereby agrees that Way Up may use such photographs and video of Participant for any lawful purpose, including publicity, illustration, advertising, and web content.

Personal Responsibility

Participant certifies that Participant has no physical or mental condition that precludes him/her from participating in the Activities and that he/she is not participating against medical advice.

Participant certifies that he/she has not consumed alcohol or illegal drugs (including medical or recreational marijuana) for at least 12 hours prior to participation in the Activities.

Participant understands that Participant’s participation in the Activities is voluntary and further understands that he/she has the opportunity to inspect the Released Parties’ equipment, aircraft, and facilities before any participation.

Participant understands that Participant is obligated to follow the rules of the Activities. Participant further agrees that he/she will not participate in the Activities unless he/she has been completely trained and has no further questions or concerns.

Participant understands that Way Up has NO INSURANCE and that the Released Parties do not provide any insurance to Participant.

If, prior to participating in the Activities, the Participant observes any unusual hazard or condition, which he/she believes jeopardizes Participant’s personal safety or that of others, Participant will remove himself/herself from participation in the Activities and immediately bring said hazard or condition to the attention of the Released Parties.

To the extent that Participant is using his/her own equipment, Participant certifies that all of his/her skydiving equipment has been manufactured under a type certificate or Technical Standard Order (“TSO”), has not be subject to non-manufacturer approved modifications, and that the reserve parachute has been repacked within 180 days of the date of this Agreement.

To the extent that Participant is participating in a tandem jump, Participant acknowledges and understands that he/she will be suited with a harness and other equipment that will allow him/her to be hooked up closely to an instructor’s body and parachute equipment. For reasons of safety and control, these points of connection need to be tightly and snugly adjusted together. This will bring Participant’s body within close proximity to the instructor. During the course of instruction, gear-up, and skydive, Participant may be touched, pushed, pulled, and/or adjusted in areas otherwise considered private or personal; however, Participant acknowledges the necessity of said actions in order to participate and acknowledges that said actions shall not constitute inappropriate physical or sexual contact, abuse, or harassment. Participant understands and acknowledges that if he/she is not comfortable with this aspect of participation in the Activities, Participant may choose to walk away and not participate. 

Governing Law, Use of Agreement, Venue, and Certification

This Agreement shall be governed by the substantive law of the State of Connecticut. To the extent that any portion of this Agreement is deemed to be invalid under the law of the State of Connecticut, the remaining portions of the Agreement shall remain binding and available for use by the Released Parties and their counsel in any proceeding. More specifically, Participant understands and agrees that this Agreement contains an acknowledgment of, and agreement to assume, the inherent risks of the Activities and may be used in court to prove same, regardless of whether a court chooses to enforce the waiver and release aspects of this document.

Venue for any dispute between Participant, Participant’s next of kin, and any of the Released Parties shall solely and exclusively be in any court of competent jurisdiction located in the State of Connecticut, regardless of Participant’s place of residence.

I UNDERSTAND THAT MY PARTICIPATION IN THE ACTIVITIES IS VOLUNTARY AND THAT I COULD CHOOSE NOT TO PARTICIPATE.

I CERTIFY THAT I AM OVER THE AGE OF EIGHTEEN (18).

I CONSENT TO THE USE OF MY ELECTRONIC SIGNATURE ON THIS AGREEMENT AND UNDERSTAND THAT MY ELECTRONIC SIGNATURE HAS THE SAME FORCE AND EFFECT AS MY ORIGINAL, HANDWRITTEN SIGNATURE.

I HAVE READ THE ABOVE WAIVER, ASSUMPTION OF THE RISK AGREEMENT, AND RELEASE, AND I UNDERSTAND THEIR TERMS. I FURTHER UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING THIS DOCUMENT, HAVE NOT CHANGED IT ORALLY, AND SIGN IT VOLUNTARILY AND WITHOUT DURESS. 

Participant's Signature:

Date: June 28, 2022

 

 

 

 S.E. Inc. d/b/a
STRONG ENTERPRISES
11236 SATELLITE BLVD.
ORLANDO, FL 32837
(407) 859-9317
(407) 850-6978
THE PARACHUTE COMPANY WITH IMAGINATION

VOLUNTEER PARACHUTE JUMPER
WAIVER AND ASSUMPTION OF RISK
AGREEMENT

READ BEFORE YOU SIGN.
YOU ARE GIVING UP IMPORTANT
LEGAL RIGHTS.

VOLUNTEER PASSENGER PARACHUTIST JUMPER WAIVER ASSUMPTION OF RISK AGREEMENT

I, (passenger parachutist), hereby acknowledge that I have reached the age of majority as dictated by the state in which I am making my Tandem jump, and I have voluntarily applied to participate in parachuting instruction and training, culminating in a parachute jump at Skydive Danielson (place of instruction and jump). I AM AWARE THAT PARACHUTE INSTRUCTION AND JUMPING ARE ULTRA HAZARDOUS ACTIVITIES, AND AM VOLUNTARILY PARTICIPATING IN THESE ACTIVITIES WITH THE KNOWLEDGE OF THE DANGER INVOLVED AND HEREBY AGREE TO ACCEPT ANY AND ALL RISKS OF PERSONAL INJURY, DEATH, OR PROPERTY DAMAGE

I Agree

In consideration of S.E. Inc. d/b/a STRONG ENTERPRISES, Strong Certified Tandem Instructors (hereinafter referred to as "Corporations") allowing me the privilege of utilizing a dual harness, dual container parachute pack assembly owned by the Corporations for the purpose of my performing an intentional parachute jump and use of their facilities, I agree as follows:

1. REPRESENTATIONS, WARRANTIES AND ASSUMPTION OF RISK.

I understand that I will be performing a parachute jump or jumps in a program pursuant to Federal Aviation Regulations 14 CFR Part 105.45, for tandem parachute jumps by persons wearing a dual harness, dual parachute pack. I understand that parachute jumping is very dangerous and that parachute jumping will expose me to risk of serious personal injury, death and/or property damage. I understand that the success of my jump depends upon the perfect functioning of the airplane from which I intend to jump and of the parachute system, but that neither the airplane nor the parachute system can be entirely depended upon to function perfectly, because each of them is subject to mechanical malfunction and operator error. For the thrill of participating in this activity, I freely and voluntarily choose to assume all the risks inherent in parachute jumping, including but not limited to risks of equipment malfunction or failure to function which may result from some defect in design or manufacture, or from improper or negligent operation or use of the equipment.  

I Agree

2. EXEMPTION FROM LIABILITY. I, my heirs, next of kin, assigns, distributees, executors, administrators, guardians, legal representatives, exempt, release and forever discharge the Corporations, their officers, directors, agents, representatives, servants, employees, shareholders, successors, assigns, suppliers and the operators of the airlift aircraft as well as the owners and lessees of land upon which the parachute jumping and related aircraft operations are conducted from any and all liability, claims, demands or actions or causes of action whatsoever arising out of damages, loss, death, injury to me or my property while participating in any of the activities contemplated by this Agreement, whether such loss, damage, or injury results from the negligence, and/or gross negligence, of the Corporations and/or any other person or business or from any other cause including injuries that may be suffered by me before, during or after the parachute jump.  

I Agree

3. COVENANT NOT TO SUE. I, my heirs, next of kin, distributees, executors, administrators, guardians, legal representatives and assigns agree never to institute any suit or action at law or otherwise against the Corporations, their officers, directors, agents, employees, representatives, servants, shareholders, suppliers, operators of airlift aircraft, or against the owners or lessees of land upon which the parachute jumping and related aircraft operations are conducted, nor to initiate or assist the prosecution of any claim for damages or cause of action which I, my heirs, next of kin, distributees, executors, administrators or assigns hereafter may have by reason of death or injury to my person or to my property arising from the activities contemplated by this Agreement which I ever had or may have in the future.  

I Agree

4. INDEMNITY AGAINST CLAIMS. I hereby agree that, my heirs, next of kin, distributees, executors, administrators, guardians, legal representatives and assigns will indemnify, save and hold harmless the Corporations, their officers, directors, agents, representatives, servants, employees, and shareholders, suppliers, and operators of airlift aircraft as well as the owners and lessees of land upon which these activities are conducted from any and all losses, claims, actions, or proceedings of every kind and character which may be presented or initiated by any persons or organizations arising directly or indirectly from my parachute jumping.  

I Agree

5. CONTINUATION OF OBLIGATIONS. I agree and acknowledge that the terms and conditions or the foregoing ASSUMPTION OF RISK, EXEMPTION FROM LIABILITY, COVENANT NOT TO SUE, and INDEMNITY AGAINST CLAIMS shall continue in full force and effect now and in the future at all times during which I participate either directly or indirectly in parachute jumping and shall be binding upon my heirs, next of kin, distributees, executors, administrators, guardians, legal representatives and assigns of my estate.  

I Agree

6. Waiver of Jury Trial/Applicable Law/Venue/Arbitration. 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 by bringing a lawsuit or claim against any of the organizations and/or persons described herein, I waive my right to a jury trial, and agree that Orange County, Florida shall be the sole venue for any suit or action arising from the activities covered by this Agreement, to which jurisdiction I, on behalf of myself, my heirs, next of kin, distributees, executors, administrators, guardians, legal representatives and assigns, agree to submit. I further agree that the Corporations, in their sole discretion, may compel me, my heirs, next of kin, distributees, executors, administrators, guardians, legal representatives and assigns to submit said claim to arbitration in accordance with the Arbitration Rules of the American Arbitration Association.  

I Agree

7. Damages, Attorneyʼs Fees and Costs. 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 herein, I, on behalf of myself, my heirs, next of kin, distributees, executors, administrators, guardians, legal representatives and assigns, agree that such organizations and/or persons shall be entitled to recover, in addition to any other damages which may be incurred, attorneyʼs fees and costs incurred in the defense of such action, including any appeals there from.  

I Agree

8. Headings. 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 FURTHER EXPRESSLY ACKNOWLEDGE AND AGREE THAT THIS AGREEMENT IS INTENDED TO BE AS BROAD AND INCLUSIVE AS IS PERMITTED BY THE LAW OR THE PROVINCE OR STATE IN WHICH THE PARACHUTE JUMP IS MADE, AND THAT IF ANY PORTION THEREOF IS HELD INVALID, IT IS AGREED THAT THE BALANCE SHALL, NOTWITHSTANDING, CONTINUE IN FULL LEGAL FORCE AND EFFECT. 

I HAVE FULLY READ THIS AGREEMENT AND FULLY UNDERSTAND AND AGREE TO ALL THE TERMS CONTAINED HEREIN BETWEEN MYSELF AND Skydive Danielson AND/OR It’s AFFILIATED ORGANIZATIONS, AND I HAVE SIGNED IT OF MY OWN FREE WILL. I FURTHER AGREE THAT NO ORAL REPRESENTATIONS, STATEMENTS OR INDUCEMENTS APART FROM THE FOREGOING WRITTEN AGREEMENT HAVE BEEN MADE, this day of June 28, 2022 At Danielson, CT.

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.

I Agree

In consideration of the Uninsured United Parachute Technologies, LLC, doing business as UPT Vector, and, 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 dual-harness, dual-container parachute pack assembly to which I will Uninsured United Parachute Technologies, LLC TANDEM PARACHUTE JUMPER AGREEMENT 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

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 June 28, 2022. 

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

First Participant's Name

First Name*

Last Name*

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

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;


List infirmities (medical or mental weakness), if not, state "none" *
Do you where corrective lenses?*
If I am prescribed corrective lenses, I agree to wear them during my intentional parachute jump.*
I AGREE
First Participant's Signature*
Second Participant's Name

First Name*

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

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;


List infirmities (medical or mental weakness), if not, state "none" *
Do you where corrective lenses?*
If I am prescribed corrective lenses, I agree to wear them during my intentional parachute jump.*
I AGREE
Third Participant's Name

First Name*

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

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;


List infirmities (medical or mental weakness), if not, state "none" *
Do you where corrective lenses?*
If I am prescribed corrective lenses, I agree to wear them during my intentional parachute jump.*
I AGREE
Fourth Participant's Name

First Name*

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

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;


List infirmities (medical or mental weakness), if not, state "none" *
Do you where corrective lenses?*
If I am prescribed corrective lenses, I agree to wear them during my intentional parachute jump.*
I AGREE
Fifth Participant's Name

First Name*

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

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;


List infirmities (medical or mental weakness), if not, state "none" *
Do you where corrective lenses?*
If I am prescribed corrective lenses, I agree to wear them during my intentional parachute jump.*
I AGREE
Sixth Participant's Name

First Name*

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

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;


List infirmities (medical or mental weakness), if not, state "none" *
Do you where corrective lenses?*
If I am prescribed corrective lenses, I agree to wear them during my intentional parachute jump.*
I AGREE
Seventh Participant's Name

First Name*

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

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;


List infirmities (medical or mental weakness), if not, state "none" *
Do you where corrective lenses?*
If I am prescribed corrective lenses, I agree to wear them during my intentional parachute jump.*
I AGREE
Eighth Participant's Name

First Name*

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

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;


List infirmities (medical or mental weakness), if not, state "none" *
Do you where corrective lenses?*
If I am prescribed corrective lenses, I agree to wear them during my intentional parachute jump.*
I AGREE
Ninth Participant's Name

First Name*

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

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;


List infirmities (medical or mental weakness), if not, state "none" *
Do you where corrective lenses?*
If I am prescribed corrective lenses, I agree to wear them during my intentional parachute jump.*
I AGREE
Tenth Participant's Name

First Name*

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

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;


List infirmities (medical or mental weakness), if not, state "none" *
Do you where corrective lenses?*
If I am prescribed corrective lenses, I agree to wear them during my intentional parachute jump.*
I AGREE
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*
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Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Email Address:

PLEASE MAKE SURE YOUR EMAIL ADDRESS IS CORRECT - YOUR VIDEO WILL BE SENT HERE.


Email Confirmation: *
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

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;


List infirmities (medical or mental weakness), if not, state "none" *
Do you where corrective lenses?*
If I am prescribed corrective lenses, I agree to wear them during my intentional parachute jump.*
I AGREE
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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