Loading...

REGISTRATION FORM

WARNING!

SKYDIVING, PARACHUTING AND ITS RELATED ACTIVITIES CAN BE DANGEROUS AND THERE ARE RISKS INVOLVED IN YOUR PARTICIPATION. YOU CAN BE SERIOUSLY INJURED OR EVEN KILLED AS A RESULT OF YOUR PARTICIPATION IN SKYDIVING OR ITS RELATED ACTIVITIES.

Date: September 28, 2020

SECTION

Medical Statement

I recognize that the sport of parachuting is a strenuous, athletic endeavor, requiring me to be in good physical condition. I hereby certify that I do not suffer from any physical infirmities or chronic illness which would affect my ability to engage in parachute training or jumping, and that I am not now under any treatment for any of the following:

  1. Cardiac or pulmonary condition or disease.
  2. High or low blood pressure.
  3. Fainting spells or convulsions.
  4. Inner or middle ear problems.
  5. Nervous disorder.
  6. Diabetes.
  7. Kidney or related diseases.
  8. Shortness of breath.
  9. Hemophilia (hemophiliacs cannot jump)
  10. Epilepsy,even controlled by medications
  11. Recentsurgery(notifytheinstructor)
  12. Dislocation of shoulder (tandem is possible, you have to notify the instructor, solo jump impossible)
  13. Reduced mobility (if I am a person with reduced mobility, I have to call the dropzone to see if my jump is possible)

*Piercings (possible injury, notify the instructor)

I further certify that I am not on any regular medication and have not taken any alcoholic beverages or drugs within eight (8) hours. I also recognize that it is against the Canadian Sport Parachuting Association (CSPA) and PARACHUTISME ADRÉNALINE’s rules and regulations to take either alcohol or drugs while engaging in parachuting activities and agree to refrain from doing so.

Assumption of Risk Agreement and Release of Liability

In consideration of PARACHUTISME ADRÉNALINE,allowing me the privilege of utilizing their facilities and equipment to engage in parachute jumping and or skydiving, ground instruction, flying and all other related activities incidental to parachute jumping and skydiving, hereinafter collectively referred to as "parachuting activities",

I, hereby agree as follows:

REPRESENTATIONS, WARRANTIES AND ASSUMPTION OF RISK

I understand that I will be performing a parachute jump or jumps/skydiving and or flying as an observer. I ALSO UNDERSTAND THAT PARACHUTE JUMPING AND OR FLYING WILL EXPOSE ME TO RISK OF PERSONAL INJURY AND DEATH. I understand that the success of my jump is dependent upon the perfect functioning of the aircraft from which I intend to jump and the parachute system, and neither the aircraft nor the parachute system can be entirely depended upon to function perfectly, but that each of them subject to mechanical malfunction and operator error. I freely and voluntarily choose to assume all risks inherent in parachute jumping, including risks of equipment malfunction or failure to function which may result from some defect in design/manufacture, improper or negligent or use of the equipment, for the thrill of participating in this activity.

I Agree

EXEMPTION FROM LIABILITY

I hereby exempt, release and discharge PARACHUTISME ADRÉNALINE, their officers, directors, agents, servants, employees, contractors, shareholders, suppliers, pilots, aircraft owners and any/ and all contracted aircraft, manufactures of equipment, the Canadian Sport Parachute Association (CSPA) and the United States Parachute Association (USPA) from any and all liability, claims, demands or cause of action whatsoever that I may hereafter have arising out of any damage, loss or injury to me or my property while participating in my activities contemplated by this agreement, whether such loss, damage or injury results from the negligence.

I Agree

INDEMNITY AGAINST CLAIMS

I will indemnify, save and hold harmless the "RELEASED PARTIES" from any and all losses, claims, 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

ASSUMPTION OF RISK

Parachuting activities, including ground instruction, parachute jumping, flying and all related activities are inherently dangerous, injuries requiring professional medical care are not uncommon and serious injury or death can and has resulted from participation in parachute activities. Not all of these risks can be foreseen or prepared for, or avoided, to the extent that even if I do everything as I was trained to do and all equipment functions properly, I can still be injured or killed.

I Agree

VOLUNTARY NATURE OF PARTICIPATION

I recognize that parachuting is an extreme sport. I agree that I am not under any compulsion to ride in or jump from a plane. My participation is only for personal satisfaction and is entirely voluntary. I agree to receive email communications from Groupe Adrénaline.

I Agree

COVENANT NOT TO SUE

I understand and acknowledge that parachuting activities have inherent dangers that no amount of care, caution, instruction or expertise can eliminate and I EXPRESS AND VOLUNTARILY ASSUME ALL RISK OF DEATH OR PERSONAL INJURY SUSTAINED WHILE PARTICIPATING IN PARACHUTING ACTIVITIES WHETHER OR NOT CAUSED BY THE NEGLIGENCE OF THE RELEASED PARTIES. I agree never to institute any suit or action of law or otherwise against the Released Parties, nor to initiate or assist the prosecution of any injury to my person or to my property arising from activities contemplated by this agreement. I agree to hold harmless and indemnify, GESTION PLANET-AIR INC., PARACHUTISME ADRÉNALINE, NADEAU MÉCANIQUE AVIATION and all of its shareholders, officers, directors, agents and employees against any claims, demands, suits, actions, causes of action, costs, damages, and liability of any kind and nature, which may arise from or out of my parachuting activities.

I Agree

CONTINUATION OF OBLIGATION

I agree and acknowledge that the terms and conditions of the foregoing EXEMPTION FROM LIABILITY, COVENANT NOT TO SUE, AND INDEMNIFY AGAINST ALL 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, executors and administrators of my estate.

I Agree

MEDIA RELEASE

I agree that if my image appears on any picture, film or videotape taken at PARACHUTISME ADRÉNALINE, I am willing to allow PARACHUTISME ADRÉNALINE to use it for publicity, informational, or entertainment purposes at no charge. I also state my willingness to be named in such materials.

The cameraman takes responsibility to provide the best product possible under the conditions encountered. The only possible compensation in case of non-operation of the video / photos option will be a refund for the cost paid for this service.

I Agree

INSURANCE

I recognize and understand that my parachuting activities including the use of the aircraft, the equipment, the site and the services offered by the employees are not covered by any personal insurance or general liability insurance issued to the Released Parties. I understand that as a parachuting student I allowed 10 jumps as a CSPA affiliated member, an affiliation offered to me by PARACHUTISME ADRÉNALINE, excluding Tandem Passengers and/or Observer Slots, or as a skydiver with previous experience I am required to belong to the Canadian Sport Parachute Association (CSPA) or the United States Parachute Association (USPA) which membership carries with it for the term of that membership Public Liability and Property Damage Insurance in my name and for my benefit.

I Agree

MINORS

I recognize that minors (14 to 18 years old) will have to make their parents complete a parental consent form. The form can be find on our website at www.parachuteadrenaline.com in the 1st jump tab, then forms.

I Agree

 

Date: September 28, 2020

Please select who will be participating...
AdultMinor
Continue
First Participant's Name

First Name*

Last Name*

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

Sex: *

Weight in feet: *

Height in lb: *

Where did you hear about Parachutisme Adrénaline? *
Do you understand that you can be seriously injured or killed from parachuting and all its related activities?*
Do you understand that by signing this document you are giving up important legal rights in exchange for the opportunity to participate in parachuting activities, and that this document can and will be used against you in a court of law?*
In spite of the above warning do you fully consent to all of the terms of this document and sign it with complete understanding and free will?*
First Participant's Signature*
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*
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
By the following, I authorize my minor child to engage in sport parachuting and/or to participate in any activity related to sport parachuting. I, as well as my child, commit to respect the rules and conditions stated in this document.
Parent or Guardian's Name

First Name*

Last Name*

Relationship*

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

Sex: *

Weight in feet: *

Height in lb: *

Where did you hear about Parachutisme Adrénaline? *
Do you understand that you can be seriously injured or killed from parachuting and all its related activities?*
Do you understand that by signing this document you are giving up important legal rights in exchange for the opportunity to participate in parachuting activities, and that this document can and will be used against you in a court of law?*
In spite of the above warning do you fully consent to all of the terms of this document and sign it with complete understanding and free will?*
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 - TRY IT FREE!