Loading...

FRONTIER SKYDIVERS, INC. AND DROP ZONE POLICIES

REFUND POLICY
The cost of your parachute jump is $50. The remainder of the fee you paid is for the training. If you do not complete the training to the instructor's satisfaction, you have two options: receive a $50 refund or attend another training class at a later date. Once aboard the aircraft there is no refund.

MEDICAL POLICY
We do not employ a medical doctor to determine your physical jump readiness. If you have physical problems which may inhibit your jumping in any way, DO NOT JUMP and consult independent medical advice. Training and jumping consists of various procedures, any one of which can result in bodily injury. It is up to you to determine whether your body can handle the rigors of parachute jumping.

BAD WEATHER POLICY
In the event that it is determined that conditions are not safe for you to jump, you may return and make your jump during our open hours. If the time period between your training and your jump exceeds 30 days, you must attend another first jump class as a refresher. There is no charge for this additional retraining if you have not yet jumped.

These are unavoidable facts of skydiving life:

  1. The instructors, pilots, riggers and ground crew are humans who are capable of making mistakes, which may result in your injury.
  2. Your equipment has been designed by human beings and can malfunction.
  3. Your training cannot be totally adequate because there is no physical way to simulate the freefall sensation while remaining on the ground. To simulate it, you must do it.

Jumping out of an aircraft is one of the most dangerous things that you can do. We tell you this repeatedly so that you cannot say we told you it was safe. It is not. We do NOT guarantee that either or both of your parachutes will open properly. We do NOT guarantee that our staff will function without error. We do NOT guarantee that you will land in the right field. We do NOT guarantee that any of our back-up devices will function properly and we CERTAINLY DO NOT guarantee that you won't get hurt. You may get hurt EVEN IF YOU DO EVERY- THING CORRECTLY! The human body is not designed for the downward impact you receive upon landing, and it may break.

NEGLIGENCE

NEGLIGENCE is defined by Webster as "failing to exercise due care. YOU are negligent (failing to exercise due care) by even attempting to skydive. Negligence could also mean poor equipment, bad training, misrepresenta- tions as to the safety of skydiving, physical or judgmental errors by the staff, or other unforeseeable situations. Gross negligence would include failure to address the obvious, such as forgetting to fuel the aircraft or failing to hook up your static line. If training or equipment is bad, we misrepresented the safety of the sport, or if you think the staff is not capable of working with you, DON'T JUMP and insist on better gear, training, or different staff to help you. The time for these types of decisions is BEFORE you jump, not after.

I have read the explanations above.

MEDICAL STATEMENT

I further certify that I am not on any regular medication and have not taken any alcoholic beverages or drugs within the last twelve (12) hours. I also recognize that it is against Federal, State, United State Parachute Associa- tion and the rules and regulations of this center to take either alcohol or drugs while engaging in parachuting activities and agree to refrain from doing so.

December 13, 2018

! NOTICE !

By signing this Agreement, Release of Liability and Assumption of Risk document you are giving up important legal rights. You are free to seek independent advice or counsel before signing.

This is not only the place that you may skydive. If you request, a list of other skydiving centers will be made available to you.

Frontier Skydivers, Inc. reserves the right to refuse participation in "parachuting activities" to any person. This document is the property of Frontier Skydivers, Inc.
 

THE AGREEMENTS BELOW ARE LEGAL CONTRACTS.

Read each paragraph very carefully and make certain that you fully understand what the paragraph says and what you are signing. If you do not fully understand, or do not fully agree to the terms,
DO NOT SIGN or initial the paragraph. Your initial or signature indicates that you agree to the terms listed.

 

AGREEMENT, RELEASE OF LIABILITY AND ASSUMPTION OF RISK

In consideration of being permitted to utilize the facilities, equipment, or training provided by Frontier Skydivers and Hollands International Airport or the services of any of its personnel or of any "Released Parties" as the term shall be defined herein to engage in parachute jumping, ground instruction, flying and related activities hereinafter collectively referred to as "parachuting activities", I hereby agree as follows:

1) Parties Included: I understand that this Agreement, Release of Liability and Assumption of Risk includes Frontier Skydivers, Inc., Hollands International Airport, their owners, agents, associated enti- ties, officers, directors, shareholders, partners, employees, pilots, instructors, jumpmasters, riggers, assistants; aircraft owners, operators, pilots, mechanics; aircraft or other contractors of providers; all property owners; all airport owners, operators and fixed base operators; manufacturers of any and all parachute or other equipment and any person, or persons or entities involved with its sale or distribu- tion; all municipalities and utilities; any individual, association, or corporation assisting in or associated with my "parachuting activities"; the United State Parachute Association and it members; all hereinafter collectively referred to as "Released Parties", which term shall include each person so released in his individual as well as any representative capacity and whether or not an employee, volunteer or inde- pendent contractor.

2) Risks Contemplated: This agreement is made in contemplation of all "parachuting activities": included but not limited to parachute jumping, ground instruction, flying and related activities, the exit, free fall, time under canopy, the landing, any rescue operations or attempts by "Released Parties" whether on, above or off the area known as Hollands International Airport, Newfane, NY or any facili- ties used by "Released Parties." 

3) I understand that I MAY BE INJURED OR KILLED, including but not limited to broken bones, inter- nal injuries, dismemberment, disfigurement, disability, permanent or otherwise, in many ways while participating in "parachuting activities" including but not limited to falls from training equipment; colli- sions with or falls from aircraft, turning propellers, other persons, parachutes, trees, power lines, build- ings, structures, machinery, vehicles, the ground, or other objects, while on the ground, or in the air, while boarding the aircraft, in the aircraft, exiting the aircraft, during the jump, while landing or after the landing; drowning; electrocution; explosions; fire; malfunction of aircraft or parachute equipment; me- teorological conditions; and acts of God. 

4) Release of Liability: I hereby RELEASE AND DISCHARGE "Released Parties" from any and all liabil- ity, claims, demands, or causes of action that I may hereafter have for injuries or damages arising out of my participation in "parachuting activities": even if caused by NEGLIGENCE, either active or passive, or other fault of "Released Parties". 

5) Covenant Not to Sue: I FURTHER AGREE THAT I WILL NOT SUE OR MAKE CLAIM AGAINST "RELEASED PARTIES" FOR DAMAGES OR OTHER LOSSES SUSTAINED AS A RESULT OF MY PAR- TICIPATION IN "PARACHUTING ACTIVITIES" EVEN IF CAUSED BY NEGLIGENCE, ACTIVE OR PASSIVE, OR OTHER FAULT OF "RELEASED PARTIES". 

6) Indemnification and Hold Harmless: I also agree toINDEMNIFY AND HOLD "Released Parties" HARMLESS from all claims, judgments and costs, including but not limited to attorney's fees, and to reimburse them for any expenses whatsoever incurred in connection with any action brought as a result of my participation in "parachuting activities". 

7) I hereby agree to pay the sum of $25,000.00 (twenty five thousand dollars) to each and every "Re- leased Parties" named in any suit or causes of action brought by me, my estate, my heirs, or anyone on my behalf, as a result of my participation in "parachuting activities".  

8) Assumption of Risk: I understand and acknowledge that "parachuting activities" are inherently dangerous and that no amount of care, caution, instruction or expertise can eliminate and I EXPRESSLY, VOLUNTARILY, AND IRREVOCABLY ASSUME ALL RISK OF DEATH OR PERSONAL INJURY SUSTAINED WHILE PARTICIPATING IN "PARACHUTING ACTIVITIES": WHETHER OR NOT CAUSED BY THE NEGLIGENCE, ACTIVE OR PASSIVE, OR OTHER FAULT OF "RELEASED PAR- TIES" including but not limited to any defect in the aircraft, equipment malfunction from whatever cause, inadequate training, any deficiencies in the landing area or surroundings, rescue attempts, bad landings, or any other injury I may sustain even if caused by negligence, active or passive, or any fault of "Released Parties".  

9) Parties Bound by this Agreement: It is my understanding and intention that this Agreement, Release of Liability and Assumption of Risk be binding not only on myself, but on anyone or any entity, includ- ing my estate and my heirs, that or who may be able to or does in fact release "Released Parties" from any and all claims or obligations whatsoever arising in any way from my participation in "parachuting activities" even if caused by the negligence, active or passive, or other fault of "Released Parties". 

10) Limitation of Warranty: "Released Parties" hereby warrant that the equipment provided by "Re- leased Parties" to include but not limited to aircraft and entire parachute system, has been previously used for "parachuting activities". This warranty is the only warranty made and is made in lieu of any other warranties, express or implied, including but not limited to warranty of merchantability or fitness for a particular purpose. I have read the above paragraph, acknowledge that I understand it and accept the limitation of warranty. 

11) I understand and acknowledge that my "parachuting activities" are not covered by any personal accident or general liability insurance issued to "Released Parties". I further assume all responsibility for any damage, harm or injury of any nature my "parachuting activities" may cause to others. 

13) Duration of Release: It is my understanding and intention that this Release is effective not only for my first jump or plane flight, but also for all subsequent jumps or flights made with the facilities or equipment of, or in any way involving the personnel of or relying on the training provided by "Released Parties". 

14) Enforceability: I agree that if any portions of this document should be found to be unenforceable or against public policy, then only such portions shall fall, but I specifically waive any unenforceability or any public policy argument that I may make or that may be made on my behalf or by or on behalf of my estate or anyone who would sue because of my, or anyone's injury or death. 

15) I hereby agree to waive any and all duty of care, whether by omission or commission, or any other duty which may be owed to me by "Released Parties". 

16) I hereby agree and it is my intention that this document be broadly construed in favor of "Released Parties" and against me and that any and all ambiguities be resolved in favor of "Released Parties".  

17) Validity of Contract: I hereby agree and understand that if any suit, demands, claim for damages or cause of action are instituted by me or on my behalf for my personal injury or death or damage to my property resulting from "parachuting activities" that this Agreement, Release of Liability and Assumption or Risk document can and will be used in court and that documents of this type have been upheld in courts in similar circumstances. 

18) I hereby agree that any and all claims, disputes or controversies whatsoever arising from or in connection with this agreement shall be commenced, filed and litigated, if at all, before a court of proper jurisdiction located in Erie County, New York, USA. It is further agreed that in the event any lawsuit is filed other than in Erie County, New York, it shall be moved there on motion at the option of "Released Parties". 

19) Whole Agreement: I acknowledge that this is the WHOLE AND ENTIRE AGREEMENT between me and the "Released Parties". I am relying on no other oral or other terms, representations, assurances or any written or printed materials of any kind. 

I HAVE CAREFULLY READ THIS AGREEMENT, RELEASE OF LIABILITY AND ASSUMPTION OF RISK, FULLY UNDERSTAND ITS CONTENTS AND SIGN IT OF MY OWN FREE WILL. I UNDER- STAND IT IS A BINDING CONTRACT AND THAT NO ORAL REPRESENTATIONS OR STATE- MENTS OF ANY KIND BY ANY PERSON CAN MODIFY THE RIGHTS AND DEFENSES IT CREATES IN THE "RELEASED PARTIES", WHICH RIGHTS AND DEFENSES MAY BE IN ADDITION TO THOSE AVAILABLE UNDER STATUES, THE COMMON LAW AND THE LAWS OF THIS JURISDICTION. Further, any written modification of this agreement shall be enforceable only if separately signed, and then against only the individual signing such modification. I recognize in signing this agreement I am giving up important legal rights, and it is my intention to do so. I have been advised that I am free to seek independent advice or counsel of my own choosing before signing this document. I further agree that should I for any reason fail to initial any part of this release, I will be deemed to have done so.

Today's Date: December 13, 2018

First Participant's Name

First Name*

Middle Name

Last Name*

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

MEDICAL STATEMENT

I recognize that the sport of parachuting is a strenuous athletic endeavor requiring me to be in good physical condition, and that even if in good physical condition, I may suffer or become prone to knee, neck, back, or other degeneration or ailments. I hereby certify that I am not aware of and do not suffer from, any physical infirmities or chronic illnesses which would affect my ability to engage in parachute training or jumping, and that I am not now under any treatment for any physical or medical condition or any of the following:

Cardiac or pulmonary condition or disease*
No
Yes
High or low blood pressure*
No
Yes
Fainting spells, convulsions, or epilepsy*
No
Yes
Hearing loss or impairment*
No
Yes
Neck or back soreness or injury of any kind*
No
Yes
Nervous or mental disorders*
No
Yes
Any orthopedic, bone musculoskeletal Condition*
No
Yes
Diabetes*
No
Yes
Kidney or related diseases*
No
Yes
Shortness of breath*
No
Yes
Drug or alcohol dependency*
No
Yes
Any impairment of alertness*
No
Yes

Normal vision? *

Glasses? *

Contact lenses? *

Height *

Weight *

Marital Status *
Do you have any physical or other impairments or past injuries that may inhibit your jumping?*
No
Yes

If "Yes" please list here and notify the staff before the class begins
Type of Jumper
Student
Licensed Jumper
Training Method
AFF
Tandem

Employer *

Work Phone *

Licensed Jumper Information


No. of Jumps to Date:

Weight with gear:

USPA Membership #:

Expires:

USPA (or CSPA) License #:

Date of Last Reserve Pack:
How Did You Hear About Us?*

If Other, please specify
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

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

MEDICAL STATEMENT

I recognize that the sport of parachuting is a strenuous athletic endeavor requiring me to be in good physical condition, and that even if in good physical condition, I may suffer or become prone to knee, neck, back, or other degeneration or ailments. I hereby certify that I am not aware of and do not suffer from, any physical infirmities or chronic illnesses which would affect my ability to engage in parachute training or jumping, and that I am not now under any treatment for any physical or medical condition or any of the following:

Cardiac or pulmonary condition or disease*
No
Yes
High or low blood pressure*
No
Yes
Fainting spells, convulsions, or epilepsy*
No
Yes
Hearing loss or impairment*
No
Yes
Neck or back soreness or injury of any kind*
No
Yes
Nervous or mental disorders*
No
Yes
Any orthopedic, bone musculoskeletal Condition*
No
Yes
Diabetes*
No
Yes
Kidney or related diseases*
No
Yes
Shortness of breath*
No
Yes
Drug or alcohol dependency*
No
Yes
Any impairment of alertness*
No
Yes

Normal vision? *

Glasses? *

Contact lenses? *

Height *

Weight *

Marital Status *
Do you have any physical or other impairments or past injuries that may inhibit your jumping?*
No
Yes

If "Yes" please list here and notify the staff before the class begins
Type of Jumper
Student
Licensed Jumper
Training Method
AFF
Tandem

Employer *

Work Phone *

Licensed Jumper Information


No. of Jumps to Date:

Weight with gear:

USPA Membership #:

Expires:

USPA (or CSPA) License #:

Date of Last Reserve Pack:
How Did You Hear About Us?*

If Other, please specify
Third Participant's Name

First Name*

Middle Name

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

MEDICAL STATEMENT

I recognize that the sport of parachuting is a strenuous athletic endeavor requiring me to be in good physical condition, and that even if in good physical condition, I may suffer or become prone to knee, neck, back, or other degeneration or ailments. I hereby certify that I am not aware of and do not suffer from, any physical infirmities or chronic illnesses which would affect my ability to engage in parachute training or jumping, and that I am not now under any treatment for any physical or medical condition or any of the following:

Cardiac or pulmonary condition or disease*
No
Yes
High or low blood pressure*
No
Yes
Fainting spells, convulsions, or epilepsy*
No
Yes
Hearing loss or impairment*
No
Yes
Neck or back soreness or injury of any kind*
No
Yes
Nervous or mental disorders*
No
Yes
Any orthopedic, bone musculoskeletal Condition*
No
Yes
Diabetes*
No
Yes
Kidney or related diseases*
No
Yes
Shortness of breath*
No
Yes
Drug or alcohol dependency*
No
Yes
Any impairment of alertness*
No
Yes

Normal vision? *

Glasses? *

Contact lenses? *

Height *

Weight *

Marital Status *
Do you have any physical or other impairments or past injuries that may inhibit your jumping?*
No
Yes

If "Yes" please list here and notify the staff before the class begins
Type of Jumper
Student
Licensed Jumper
Training Method
AFF
Tandem

Employer *

Work Phone *

Licensed Jumper Information


No. of Jumps to Date:

Weight with gear:

USPA Membership #:

Expires:

USPA (or CSPA) License #:

Date of Last Reserve Pack:
How Did You Hear About Us?*

If Other, please specify
Fourth Participant's Name

First Name*

Middle Name

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

MEDICAL STATEMENT

I recognize that the sport of parachuting is a strenuous athletic endeavor requiring me to be in good physical condition, and that even if in good physical condition, I may suffer or become prone to knee, neck, back, or other degeneration or ailments. I hereby certify that I am not aware of and do not suffer from, any physical infirmities or chronic illnesses which would affect my ability to engage in parachute training or jumping, and that I am not now under any treatment for any physical or medical condition or any of the following:

Cardiac or pulmonary condition or disease*
No
Yes
High or low blood pressure*
No
Yes
Fainting spells, convulsions, or epilepsy*
No
Yes
Hearing loss or impairment*
No
Yes
Neck or back soreness or injury of any kind*
No
Yes
Nervous or mental disorders*
No
Yes
Any orthopedic, bone musculoskeletal Condition*
No
Yes
Diabetes*
No
Yes
Kidney or related diseases*
No
Yes
Shortness of breath*
No
Yes
Drug or alcohol dependency*
No
Yes
Any impairment of alertness*
No
Yes

Normal vision? *

Glasses? *

Contact lenses? *

Height *

Weight *

Marital Status *
Do you have any physical or other impairments or past injuries that may inhibit your jumping?*
No
Yes

If "Yes" please list here and notify the staff before the class begins
Type of Jumper
Student
Licensed Jumper
Training Method
AFF
Tandem

Employer *

Work Phone *

Licensed Jumper Information


No. of Jumps to Date:

Weight with gear:

USPA Membership #:

Expires:

USPA (or CSPA) License #:

Date of Last Reserve Pack:
How Did You Hear About Us?*

If Other, please specify
Fifth Participant's Name

First Name*

Middle Name

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

MEDICAL STATEMENT

I recognize that the sport of parachuting is a strenuous athletic endeavor requiring me to be in good physical condition, and that even if in good physical condition, I may suffer or become prone to knee, neck, back, or other degeneration or ailments. I hereby certify that I am not aware of and do not suffer from, any physical infirmities or chronic illnesses which would affect my ability to engage in parachute training or jumping, and that I am not now under any treatment for any physical or medical condition or any of the following:

Cardiac or pulmonary condition or disease*
No
Yes
High or low blood pressure*
No
Yes
Fainting spells, convulsions, or epilepsy*
No
Yes
Hearing loss or impairment*
No
Yes
Neck or back soreness or injury of any kind*
No
Yes
Nervous or mental disorders*
No
Yes
Any orthopedic, bone musculoskeletal Condition*
No
Yes
Diabetes*
No
Yes
Kidney or related diseases*
No
Yes
Shortness of breath*
No
Yes
Drug or alcohol dependency*
No
Yes
Any impairment of alertness*
No
Yes

Normal vision? *

Glasses? *

Contact lenses? *

Height *

Weight *

Marital Status *
Do you have any physical or other impairments or past injuries that may inhibit your jumping?*
No
Yes

If "Yes" please list here and notify the staff before the class begins
Type of Jumper
Student
Licensed Jumper
Training Method
AFF
Tandem

Employer *

Work Phone *

Licensed Jumper Information


No. of Jumps to Date:

Weight with gear:

USPA Membership #:

Expires:

USPA (or CSPA) License #:

Date of Last Reserve Pack:
How Did You Hear About Us?*

If Other, please specify
Sixth Participant's Name

First Name*

Middle Name

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

MEDICAL STATEMENT

I recognize that the sport of parachuting is a strenuous athletic endeavor requiring me to be in good physical condition, and that even if in good physical condition, I may suffer or become prone to knee, neck, back, or other degeneration or ailments. I hereby certify that I am not aware of and do not suffer from, any physical infirmities or chronic illnesses which would affect my ability to engage in parachute training or jumping, and that I am not now under any treatment for any physical or medical condition or any of the following:

Cardiac or pulmonary condition or disease*
No
Yes
High or low blood pressure*
No
Yes
Fainting spells, convulsions, or epilepsy*
No
Yes
Hearing loss or impairment*
No
Yes
Neck or back soreness or injury of any kind*
No
Yes
Nervous or mental disorders*
No
Yes
Any orthopedic, bone musculoskeletal Condition*
No
Yes
Diabetes*
No
Yes
Kidney or related diseases*
No
Yes
Shortness of breath*
No
Yes
Drug or alcohol dependency*
No
Yes
Any impairment of alertness*
No
Yes

Normal vision? *

Glasses? *

Contact lenses? *

Height *

Weight *

Marital Status *
Do you have any physical or other impairments or past injuries that may inhibit your jumping?*
No
Yes

If "Yes" please list here and notify the staff before the class begins
Type of Jumper
Student
Licensed Jumper
Training Method
AFF
Tandem

Employer *

Work Phone *

Licensed Jumper Information


No. of Jumps to Date:

Weight with gear:

USPA Membership #:

Expires:

USPA (or CSPA) License #:

Date of Last Reserve Pack:
How Did You Hear About Us?*

If Other, please specify
Seventh Participant's Name

First Name*

Middle Name

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

MEDICAL STATEMENT

I recognize that the sport of parachuting is a strenuous athletic endeavor requiring me to be in good physical condition, and that even if in good physical condition, I may suffer or become prone to knee, neck, back, or other degeneration or ailments. I hereby certify that I am not aware of and do not suffer from, any physical infirmities or chronic illnesses which would affect my ability to engage in parachute training or jumping, and that I am not now under any treatment for any physical or medical condition or any of the following:

Cardiac or pulmonary condition or disease*
No
Yes
High or low blood pressure*
No
Yes
Fainting spells, convulsions, or epilepsy*
No
Yes
Hearing loss or impairment*
No
Yes
Neck or back soreness or injury of any kind*
No
Yes
Nervous or mental disorders*
No
Yes
Any orthopedic, bone musculoskeletal Condition*
No
Yes
Diabetes*
No
Yes
Kidney or related diseases*
No
Yes
Shortness of breath*
No
Yes
Drug or alcohol dependency*
No
Yes
Any impairment of alertness*
No
Yes

Normal vision? *

Glasses? *

Contact lenses? *

Height *

Weight *

Marital Status *
Do you have any physical or other impairments or past injuries that may inhibit your jumping?*
No
Yes

If "Yes" please list here and notify the staff before the class begins
Type of Jumper
Student
Licensed Jumper
Training Method
AFF
Tandem

Employer *

Work Phone *

Licensed Jumper Information


No. of Jumps to Date:

Weight with gear:

USPA Membership #:

Expires:

USPA (or CSPA) License #:

Date of Last Reserve Pack:
How Did You Hear About Us?*

If Other, please specify
Eighth Participant's Name

First Name*

Middle Name

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

MEDICAL STATEMENT

I recognize that the sport of parachuting is a strenuous athletic endeavor requiring me to be in good physical condition, and that even if in good physical condition, I may suffer or become prone to knee, neck, back, or other degeneration or ailments. I hereby certify that I am not aware of and do not suffer from, any physical infirmities or chronic illnesses which would affect my ability to engage in parachute training or jumping, and that I am not now under any treatment for any physical or medical condition or any of the following:

Cardiac or pulmonary condition or disease*
No
Yes
High or low blood pressure*
No
Yes
Fainting spells, convulsions, or epilepsy*
No
Yes
Hearing loss or impairment*
No
Yes
Neck or back soreness or injury of any kind*
No
Yes
Nervous or mental disorders*
No
Yes
Any orthopedic, bone musculoskeletal Condition*
No
Yes
Diabetes*
No
Yes
Kidney or related diseases*
No
Yes
Shortness of breath*
No
Yes
Drug or alcohol dependency*
No
Yes
Any impairment of alertness*
No
Yes

Normal vision? *

Glasses? *

Contact lenses? *

Height *

Weight *

Marital Status *
Do you have any physical or other impairments or past injuries that may inhibit your jumping?*
No
Yes

If "Yes" please list here and notify the staff before the class begins
Type of Jumper
Student
Licensed Jumper
Training Method
AFF
Tandem

Employer *

Work Phone *

Licensed Jumper Information


No. of Jumps to Date:

Weight with gear:

USPA Membership #:

Expires:

USPA (or CSPA) License #:

Date of Last Reserve Pack:
How Did You Hear About Us?*

If Other, please specify
Ninth Participant's Name

First Name*

Middle Name

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

MEDICAL STATEMENT

I recognize that the sport of parachuting is a strenuous athletic endeavor requiring me to be in good physical condition, and that even if in good physical condition, I may suffer or become prone to knee, neck, back, or other degeneration or ailments. I hereby certify that I am not aware of and do not suffer from, any physical infirmities or chronic illnesses which would affect my ability to engage in parachute training or jumping, and that I am not now under any treatment for any physical or medical condition or any of the following:

Cardiac or pulmonary condition or disease*
No
Yes
High or low blood pressure*
No
Yes
Fainting spells, convulsions, or epilepsy*
No
Yes
Hearing loss or impairment*
No
Yes
Neck or back soreness or injury of any kind*
No
Yes
Nervous or mental disorders*
No
Yes
Any orthopedic, bone musculoskeletal Condition*
No
Yes
Diabetes*
No
Yes
Kidney or related diseases*
No
Yes
Shortness of breath*
No
Yes
Drug or alcohol dependency*
No
Yes
Any impairment of alertness*
No
Yes

Normal vision? *

Glasses? *

Contact lenses? *

Height *

Weight *

Marital Status *
Do you have any physical or other impairments or past injuries that may inhibit your jumping?*
No
Yes

If "Yes" please list here and notify the staff before the class begins
Type of Jumper
Student
Licensed Jumper
Training Method
AFF
Tandem

Employer *

Work Phone *

Licensed Jumper Information


No. of Jumps to Date:

Weight with gear:

USPA Membership #:

Expires:

USPA (or CSPA) License #:

Date of Last Reserve Pack:
How Did You Hear About Us?*

If Other, please specify
Tenth Participant's Name

First Name*

Middle Name

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

MEDICAL STATEMENT

I recognize that the sport of parachuting is a strenuous athletic endeavor requiring me to be in good physical condition, and that even if in good physical condition, I may suffer or become prone to knee, neck, back, or other degeneration or ailments. I hereby certify that I am not aware of and do not suffer from, any physical infirmities or chronic illnesses which would affect my ability to engage in parachute training or jumping, and that I am not now under any treatment for any physical or medical condition or any of the following:

Cardiac or pulmonary condition or disease*
No
Yes
High or low blood pressure*
No
Yes
Fainting spells, convulsions, or epilepsy*
No
Yes
Hearing loss or impairment*
No
Yes
Neck or back soreness or injury of any kind*
No
Yes
Nervous or mental disorders*
No
Yes
Any orthopedic, bone musculoskeletal Condition*
No
Yes
Diabetes*
No
Yes
Kidney or related diseases*
No
Yes
Shortness of breath*
No
Yes
Drug or alcohol dependency*
No
Yes
Any impairment of alertness*
No
Yes

Normal vision? *

Glasses? *

Contact lenses? *

Height *

Weight *

Marital Status *
Do you have any physical or other impairments or past injuries that may inhibit your jumping?*
No
Yes

If "Yes" please list here and notify the staff before the class begins
Type of Jumper
Student
Licensed Jumper
Training Method
AFF
Tandem

Employer *

Work Phone *

Licensed Jumper Information


No. of Jumps to Date:

Weight with gear:

USPA Membership #:

Expires:

USPA (or CSPA) License #:

Date of Last Reserve Pack:
How Did You Hear About Us?*

If Other, please specify
Participant's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

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

Emergency Contact's Name*

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

Driver's License / ID Card Number*

Issuing State*
I certify that I have ( ); have not ( ) seen the video warning.*
12) I hereby certify that I (do ); (do not ) carry personal insurance coverage sufficient to prevent financial hardship to myself, my dependents, my estate, and my heirs in the event of my injury or death as a result of my participation in "parachuting activities".*
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 Information

MEDICAL STATEMENT

I recognize that the sport of parachuting is a strenuous athletic endeavor requiring me to be in good physical condition, and that even if in good physical condition, I may suffer or become prone to knee, neck, back, or other degeneration or ailments. I hereby certify that I am not aware of and do not suffer from, any physical infirmities or chronic illnesses which would affect my ability to engage in parachute training or jumping, and that I am not now under any treatment for any physical or medical condition or any of the following:

Cardiac or pulmonary condition or disease*
No
Yes
High or low blood pressure*
No
Yes
Fainting spells, convulsions, or epilepsy*
No
Yes
Hearing loss or impairment*
No
Yes
Neck or back soreness or injury of any kind*
No
Yes
Nervous or mental disorders*
No
Yes
Any orthopedic, bone musculoskeletal Condition*
No
Yes
Diabetes*
No
Yes
Kidney or related diseases*
No
Yes
Shortness of breath*
No
Yes
Drug or alcohol dependency*
No
Yes
Any impairment of alertness*
No
Yes

Normal vision? *

Glasses? *

Contact lenses? *

Height *

Weight *

Marital Status *
Do you have any physical or other impairments or past injuries that may inhibit your jumping?*
No
Yes

If "Yes" please list here and notify the staff before the class begins
Type of Jumper
Student
Licensed Jumper
Training Method
AFF
Tandem

Employer *

Work Phone *

Licensed Jumper Information


No. of Jumps to Date:

Weight with gear:

USPA Membership #:

Expires:

USPA (or CSPA) License #:

Date of Last Reserve Pack:
How Did You Hear About Us?*

If Other, please specify
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver