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Parachutist liability release, waiver, discharge and covenant not to sue

Parachutist waiver

The undersigned hereby declares:

that he/she is in possesion of the following:

  • a valid medical certificate for parachute jumping (this is not necessary for Tandems);
  • a valid third party insurance for parachute jumping;
  • a valid medical insurance; (not for Tandemjumping)

The under mentioned states by way of undersigning of this document that they are aware of:

  • The fact that participation in sport parachuting is potentially hazardous.
     
  • The fact that the Paracentrum Texel B.V. and joint partnerships and combined activities and/or personnel are in no way responsible, for either material or immaterial damages caused as a direct or indirect result of an accident that has occured to the under mentioned while practicing the sport of parachute jumping;
     
  • The under mentioned explictly waivers the right for themselves, as well as for their heirs the right of succession or any form of legal representation in        which a claim for compensation against the Paracentrum Texel B.V. and /or the direction and/or staff and/or anyone representing the Paracentrum, directly or indirectly as the result of and/or in connection with parachute jumping and/or while on the property, in the hangars or any other building belonging the Paracentrum Texel B.V. and/or any related partnerships under their management at the time, against damages or sustained injuries in any form, regardless of the fact that these damages resulted during the training course or while parachuting;
     
  • The fact that the Paracentrum Texel B.V. and her joint partnerships and combined activities and/or personnel, etc. are protected against any liabilities in any such form for restitution as a result of direct or indirect damage(s) (including material or immaterial) from their heirs or legal representation pertaining to any possible incurred damages, remaining injuries, workman’s compensation, disablement, etc.;
     
  • That the under signed is bodily as well as mentally fit state to perform a parachute jump or tandem jump and is aware of all the consequences that pertain to parachute jumping and have been briefes of all possibilities by the Paracentrum Texel B.V. and have understood and accept the consequences;
     
  • That the under signed are aware of the rules and regulations, etc. at the Paracentrum Texel, and understand and will conform to them.

May 22, 2019

Select who will be participating in parachuting activities
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First Parachutist Name

First Name*

Last Name*

Phone*
First Parachutist Date of Birth*
First Parachutist weight

Kilograms *
First Parachutist Signature*
Parachutist 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*
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*

Relationship*

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

Kilograms *
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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