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Des Moines Skydivers, LLC waiver Revised 02/20/2019.

MEDICAL STATEMENT

NOTICE: All medical information provided is for the use of the Des Moines Skydivers, LLC in case you are injured. YOU ARE SOLELY RESPONSIBLE for determining whether you are fit to jump. 

I Agree

RELEASE OF LIABILITY AND AGREEMENT

In consideration for being permitted to utilize the facilities and equipment owned or arranged by the Des Moines Skydivers, LLC. (hereinafter "DMSD"), I hereby agree as follows:

1.   VOLUNTARY PARTICIPATION. I understand that I am not required to participate in any skydiving-related activi­ties. I further understand that, to the extent that I choose to participate in skydiving-related activities, I am not required to do so with DMSD. I know that there are other skydiving operations to which I may go within a 200-mile radius of Des Moines or such other location where this agreement is being signed. I also know that I am free to change my mind about participat­ing in skydiving-related activities at any time. I understand that DMSD will fully refund any payments I have made, other than my deposit, should I decide not to engage in skydiving-related activities with DMSD out of concern for my health or safety, out of a desire not to assume the serious risks associated with such activities, or out of a desire not to be bound by this agreement.

I Agree

2.   PARTIES COVERED.  This release of liability and agreement covers DMSD, its members, managers, employees, affiliated organizations, agents, independent contractors, volunteers, and others providing services or facilities at its request or direction. Without limiting the foregoing, this release specifically covers skydiving instructors, videographers, riggers, parachute packers, pilots, aircraft owners, airport owners or authorities, airport operators, all members of DMSD, the United States Parachute Association, all equipment manufacturers and dealers of skydive equipment and any of the foregoing persons' or entities' employees, officers, directors, managers, or the like. 

I Agree

3.   RISKS CONTEMPLATED. This release of liability and agreement contemplates all risks of injury, death, property damage, or other damage to myself or others associated with my participation in skydiving-related activities and my presence on or in the vicinity of an airport at which skydiving-related activities are occurring, regardless of whether such risks are unforeseen by me or others or whether the particular events causing injury, death, or damage are unexpected or are of an unlikely nature. Without limiting the foregoing, I understand that such risks may include injury or death caused by the negli­gence of myself or one or more of the parties covered by this release in any of the following: instructing or jump-mastering, putting on equipment, attaching equipment to the aircraft or to a tandem parachute, maintaining equipment, facilities, or aircraft, packing main or reserve parachutes, piloting the aircraft on the ground or in the air, taking me or others on a tandem or solo skydive, operating skydiving equipment, freefalling or operating a parachute alone or near others, landing a parachute with or without guidance, engaging or failing to engage in emergency or rescue efforts, providing or failing to provide infor­ mation or assistance to rescuers, transporting me or others by vehicle, allowing other persons to be present or to engage in any skydiving-related activities, or allowing animals to be present. I understand that I or others can be seriously injured or killed by any aspect of skydiving, including, but not limited to, aircraft mishaps or crashes, equipment failures, hard para­chute openings or landings, failure of a parachute to fully open, high-speed impacts with the ground, entanglement or stran­gulation by lines or bridles, being struck by other skydivers or objects in freefall, under canopy, or while on the ground, or being struck by aircraft or their propellers while in the air or on the ground. I also understand that I or others can be injured or killed while on, in or in the vicinity of--or as a result of having been on, in, or in the vicinity of--the facilities of DMSD, such as by falling, being hit by persons, objects, or vehicles, being attacked by animals, being injured while riding as a pas­senger in a vehicle, or being injured as a result of having consumed alcoholic beverages.  It is my intent for this release of liability and agreement to also apply to the covered parties for any and all such peripheral risks. 

I Agree

4.   RELEASE OF LIABILITY AND INDEMNITY.  I hereby release and discharge DMSD and the covered parties from any and all liability, claims, demands, or causes of action I or others may hereafter have for injury, death, property damage, or other damages from any of the contemplated risks, even if caused by the negligence, ordinary or gross, of DMSD or such covered parties. This release shall bind my heirs, successors, and assigns. I further agree to indemnify and hold harmless DMSD and the covered parties from all claims, judgments and costs, including but not limited to reasonable attorney's fees, and to reimburse them for any expenses whatsoever incurred in connection with any claim, action, or lawsuit brought as a result of my participation in skydiving-related activities, whether brought by myself, my estate, or by others, including claims by my spouse, children, family, or persons injured or damaged by me. 

I Agree

5.   PHYSICAL AND MENTAL FITNESS.  I hereby certify that I am physically and mentally fit to participate in sky­diving-related activities. I understand that I am solely responsible for making this determination and that the provision of medical information to DMSD on this form or otherwise does not in any way constitute my reliance upon DMSD or the cov­ered parties to make this determination on my behalf. 

I Agree

6.   COMPLETE AGREEMENT.  This document constitutes the complete agreement between myself and DMSD. No amendments to this agreement shall be of effect unless in writing and signed by me and all the managers of DMSD. 

I Agree

December 6, 2019

TANDEM PARACHUTE JUMPER AGREEMENT
UNINSURED UNITED PARACHUTE TECHNOLOGIES, LLC

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 Des Moines Skydivers, LLC, 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 risk 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 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., 1-800FREEFALL, 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 para­ graph 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 I have disclosed all infirmities and medications in the Medical Information section (or indicated "none" if not applicable). 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

I freely and voluntarily agree to all of the above by signing this contract on the date indicated. 

December 6, 2019 

VOLUNTEER PARACHUTE JUMPER WAIVER AND ASSUMPTION OF RISK AGREEMENT
STRONG ENTERPRISES

Carefully read and understand the entire document, because by signing it, you are agreeing to give up certain legal rights.  

I Agree

I, the voluntary parachute jumper indicated, 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  Des Moines Skydivers in Winterset, Iowa.

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.

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, ATTORNEY'S 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, attorney's 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 Agree

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 Agree

I HAVE FULLY READ THIS AGREEMENT AND FULLY UNDERSTAND AND AGREE TO ALL THE TERMS CONTAINED HEREIN BETWEEN MYSELF AND Des Moines Skydivers, LLC AND/OR ITS 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,

December 6, 2019 

First Voluntary Parachute Jumper Name

First Name*

Middle Name

Last Name*

Phone*
First Voluntary Parachute Jumper Date of Birth*
First Voluntary Parachute Jumper Signature*
Second Voluntary Parachute Jumper Name

First Name*

Middle Name

Last Name*
Second Voluntary Parachute Jumper Date of Birth*
Third Voluntary Parachute Jumper Name

First Name*

Middle Name

Last Name*
Third Voluntary Parachute Jumper Date of Birth*
Fourth Voluntary Parachute Jumper Name

First Name*

Middle Name

Last Name*
Fourth Voluntary Parachute Jumper Date of Birth*
Fifth Voluntary Parachute Jumper Name

First Name*

Middle Name

Last Name*
Fifth Voluntary Parachute Jumper Date of Birth*
Sixth Voluntary Parachute Jumper Name

First Name*

Middle Name

Last Name*
Sixth Voluntary Parachute Jumper Date of Birth*
Seventh Voluntary Parachute Jumper Name

First Name*

Middle Name

Last Name*
Seventh Voluntary Parachute Jumper Date of Birth*
Eighth Voluntary Parachute Jumper Name

First Name*

Middle Name

Last Name*
Eighth Voluntary Parachute Jumper Date of Birth*
Ninth Voluntary Parachute Jumper Name

First Name*

Middle Name

Last Name*
Ninth Voluntary Parachute Jumper Date of Birth*
Tenth Voluntary Parachute Jumper Name

First Name*

Middle Name

Last Name*
Tenth Voluntary Parachute Jumper Date of Birth*
Voluntary Parachute Jumper 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 and news from Des Moines Skydivers via email.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Parent or Guardian's Driver's License / ID Card

Driver's License / ID Card Number*

Issuing State*
Medical Information
Do you have vision (corrected or uncorrected) adequate to obtain a driver's license?*
No
Yes

What is your uncorrected vision?
Do you wear the following?
Glasses
Contacts
None

Please indicate whether you have been diagnosed with, treated for, or experienced each of the following conditions at any time in the past five years.

Cardiac or pulmonary condition or disease*
No
Yes
High or low blood pressure*
No
Yes
Fainting spells, convulsions, or epilepsy*
No
Yes
Hearing loss*
No
Yes
Nervous or mental disorder*
No
Yes
Diabetes*
No
Yes
Kidney or related diseases*
No
Yes
Neck, back, hip, knee, ankle, or foot injury*
No
Yes
Any orthopedic problems*
No
Yes
Alcoholism or drug addiction or dependency*
No
Yes

If you indicated "yes" in response to any of the above, describe the condition in further detail, including its severity, frequency, last occurrence, method and level of control, and impact upon your functioning:

List your current medications and the conditions for which you take them:
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*

Middle Name

Last Name*

Phone*
Parent or Guardian's Date of Birth*
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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