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AerOhio Skydiving, LLC

ADULT RELEASE OF LIABILITY, ASSUMPTION OF RISK, WAIVER AND INDEMNITY AGREEMENT, AND AGREEMENT NOT TO SUE

The terms of this Release, Waiver and Indemnity Agreement are contractual and not mere recital and contain the entire agreement between the parties hereto. WARNING: Skydiving, parachuting, and flying are exciting and challenging activities. However, THE RISK OF SERIOUS INJURY OR DEATH IS REAL and should not be overlooked or underestimated. You are exposing yourself to extreme danger. DO NOT PARTICIPATE unless you accept these risks.


I indicate that I understand and accept the terms and conditions by signing my initials, selecting the “I Agree” checkboxes and/or affixing my signature to this document and HEREBY AGREE AS FOLLOWS:

1. RISKS CONTEMPLATED: This Contract of Agreement is made in contemplation of all skydiving and parachuting activities, including but not limited to the following: ground-based instruction, training and practice; ground transportation between airports and parachute landing areas; boarding and disembarking the aircraft on the ground, aircraft taxi operations, aircraft take-off and landing operations, flying in aircraft, any other aircraft-related activity; exiting the aircraft while in flight, freefall skydiving, accelerated freefall skydiving, tandem skydiving, parachute deployment, actions taken to address parachute malfunctions, parachute flying and steering, parachute landing, and any rescue operations or attempts by the Released Parties whether on, above, or off of any facilities used by or associated with the Released Parties

2. PARTIES INCLUDED:  For other valuable consideration, hereby acknowledged and with full knowledge of the perils and dangerous nature of the aforementioned “Parachuting Activities”, the risk of which is hereby assumed, I for myself, and as the only legal representative of my heirs, executors, administrators, assigns, beneficiaries, dependents, family, relatives, spouse, and estate do hereby fully and FOREVER RELEASE AND DISCHARGE AerOhio Skydiving, LLC, Shermarge, LLC, Wink's Down to Earth, Inc., Ohio Skydiving Center, David Lepka, Linda Winkler, Sherry Butcher, Ashland County Airport, Ashland County Airport Authority, AerOhio Aviation, LLC, Fayard Enterprises, their officers, managers, commissioners, directors, shareholders, agents, representatives, employees, volunteers, pilots, aircraft owners, any other aircraft owners and pilots, instructors, coaches, riggers, employees, contractors, stockholders, drop-zone owners, successors and assigns, the United States Parachute Association, the Toll-Free Skydive Network, Inc., manufacturers, distributors and dealers of any and all of the equipment I use for my parachute jump, and all persons whomever directly or indirectly liable, (hereinafter referred to as "The Released Parties") 

3. RELEASE FROM LIABILITY:  From any and all claims and demands, actions or causes of action, damages, cost, loss of services, expenses and all other claims of damages whatsoever, both in law and in equity on account of or any way resulting from bodily injury, disfigurement, conscious suffering, death, negligent infliction of emotional distress, or property damages sustained by me, arising out of aircraft flights, skydiving, parachute jumps, or any other means of lift, ascent or descent, from an aircraft of any nature, or arising out of the ownership, operation, use, maintenance or control of any vehicle, aircraft, or otherwise, or any device or mooring, while on the ground or in flight, and meaning and intending to include herein all such bodily injury, disfigurement, conscious suffering, death, negligent infliction of emotional distress, or property damage resulting from or in any way connected with or arising out of instruction, training, and ground or air operations incidental thereto.

4. CONVENANT NOT TO SUE:  I further agree that I WILL NOT SUE OR MAKE A CLAIM AGAINST THE RELEASED PARTIES for damages or other losses sustained by me as a result of my participation in “Parachuting Activities.” I also agree to INDEMNIFY AND HOLD “THE RELEASED PARTIES” FOREVER HARMLESS from all claims, judgments and costs, including but not limited to attorney's fees, incurred in connection with any action brought as a result of my participation in “Parachuting Activities.” 

5. INDEMNIFICATION AND HOLD HARMLESS. I also agree to indemnify and hold the Released Parties harmless from all claims, judgements and costs; including but not limited to attorney’s fees, and to pay for any expenses whatsoever incurred by the Released Parties in connection with any action brought by me as a result of my participation in skydiving and parachuting activities. 

6. ASSUMPTION OF RISK: I understand and acknowledge that parachuting is a DANGEROUS, CALCULATED RISK ACTIVITY which can, and sometimes does result in BODILY INJURY OR DEATH to its' participants. I understand and acknowledge that I will be jumping out of an airplane in flight, which is known to be a very dangerous thing to do. I understand and acknowledge that I CAN BE INJURED OR KILLED, EVEN IF I DO EVERYTHING PROPERLY. I am accepting this risk in order to be allowed to jump of my own free will, with full understanding of the possible consequences and potential dangers, and without inducements, promises, or statements other than those contained in this Release of Liability, Waiver, and Indemnity Agreement. I understand and acknowledge that parachuting activities have inherent dangers that no amount of care, caution, instruction, or expertise can eliminate. I EXPRESSLY AND VOLUNTARILY ASSUME ALL RISKS, LIABILITY, DUTY OF CARE, AND RESPONSIBILITY FOR DEATH OR BODILY INJURY SUSTAINED WHILE PARTICIPATING IN “PARACHUTING ACTIVITIES” WHETHER SUCH RISK IS FORESEEN OR UNFORESEEN, CONTIPLATED OR NOT CONTIPLATED, CAUSED OR NOT CAUSED BY THE NEGLIGENCE OF “THE RELEASED PARTIES including but not limited to, equipment malfunction from whatever cause, inadequate training, any deficiencies in the landing area, rescue attempts, bad landings, or any other injury I may sustain even if caused by the negligence, in any degree, or fault of “The Released Parties.” I understand that I am releasing all claims or potential claims which could be asserted or are assertible by or through me, even if these claims arise out of the negligence of "The Released Parties."  

7. PARTIES BOUND BY THIS AGREEMENT: It is my understanding and intention that this Release and Agreement by binding not only on myself but on anyone or an entity, including my estate and heirs, that or who may be able to or does sue because of my injury or death. I also instruct my heirs, family, friends, and executors or administrators of my estate that they are NOT authorized to file any lawsuits or claims for loss, reimbursement or damages of any kind in the event of my death or bodily injury. It is further my understanding and agreement that this Release is intended to and does release the Released Parties from any and all claims or obligations whatsoever arising in any way from my participation in skydiving and parachuting activities even if cause by negligence, gross negligence, or other fault. I understand and accept all risks, duty of care, responsibility and liability related to or arising from skydiving and related activities.” 

8. LIMITATIONS OF WARRANTY: I hereby acknowledge that there is a Limitation of Warranty on the equipment provided to me for skydiving, parachuting, and flying activities and that this equipment is warranted only to the extent that it has been used previously for “Parachuting Activities.” This warranty is the only warranty made to me by “The Released Parties” and is made in lieu of any other warranties, expressed, or implied, including but not limited to warranty of merchantability or fitness for a particular purpose. By initialing below, I acknowledge that I understand and accept this limitation of warranty. 

9. DURATION OF RELEASE:  I hereby agree and acknowledge that all of the terms and conditions of this Release, Waiver and Indemnity Agreement shall continue in full force and effect, now and in the future, at all times during which I participate either directly or indirectly in skydiving and parachuting activities not only for my first jump but for any subsequent jumps; and shall be binding upon my heirs, representatives, successors, administrators, assigns, families, dependents, friends and executors of my estate. 

10. ENFORCEABILITY: I further understand and agree that if I, or anyone on my behalf, initiates any suit or action of law against any of "The Released Parties" for any loss, no matter how minor or severe, to my person or property, that this document will be used in court. I also understand that agreements of this type have been upheld in courts in similar circumstances. Should any provision of this indemnity and release agreement be held or deemed to be unenforceable, invalid, or voided, the remaining provisions of this agreement shall nevertheless be binding upon and enforceable against the parties hereto, their respective heirs, executors, administrators, assigns, personal representatives, family, relatives, and spouses. 

11. INSURANCE COVERAGE CERTIFICATION:  I hereby certify that I have adequate insurance coverage, both medical and life, to cover any eventuality arising from my participation in parachuting activities, or may be inadequate to cover any eventuality arising from my participation in parachuting activities. I elect to participate in parachuting activities with my current level of coverage regardless of what that coverage may be. 

Further, I certify that considering my lifestyle and the manner in which I am supporting my dependents, I have made adequate provisions for my spouse, if any; children, if any; my heirs, if any; and all other persons dependent on me so that in the event of my death or disability, they will have suffered no financial loss.

I Agree

12. EMERGENCY MEDICAL SERVICES:  In the event, I sustain any injury while participating in parachuting activities, I authorize representatives of AerOhio Skydiving, LLC to call emergency medical services for treatment or transport to a medical treatment facility. It is understood that this will be at my own expense, and is not covered by any general liability insurance of "The Released Parties." 

I Agree

13. DRUG AND ALCOHOL USE: I further certify that I have not taken any alcoholic beverages or non-prescription or prescription drugs that could affect my ability to participate in “Parachuting Activities” within the last 8 hours. I also recognize that it is against Federal, State and USPA regulations to take either alcohol or drugs while engaging in parachuting activities and agree to refrain from doing so. 

I Agree

14. MEDICAL STATEMENT: The United States Parachute Association recommends that all skydiving participants receive a FAA Class III medical examination or be examined by a physician prior to making a parachute jump. In lieu of this certification, all participants must complete the following medical statement: “I represent and warrant that I have no known physical or mental infirmities that would impair my ability to participate in skydiving, or if I do have any such infirmities, that they have been or are being successfully treated so that they do not represent any foreseeable risk while skydiving. I also represent and warrant that I am not taking any medications or substances, prescription, or otherwise, that would impair my ability to participate in skydiving.                                                                                                                                 

I agree to consult with a medical professional if I have any questions concerning any medical conditions, which might affect my participation in skydiving and parachuting activities. I understand that AerOhio Skydiving, LLC and their representatives cannot make any medical determination for me. 

I Agree

15. HARNESS FITTING PROCEDURES: I understand that it is necessary for me to be suited with a harness/container system when doing an Accelerated Freefall (AFF) or a harness which will allow me to be hooked to my instructor's harness when doing a Tandem skydive. I further understand that, for safety reasons, it is imperative that this harness fit snugly about my body and it may be necessary for my instructor or other staff to touch me in places I find personal or offensive, in order to insure the security of this harness system. I further understand that the harness, when attached to the Instructor during an actual Tandem skydive, places my body in close proximity to that of my instructor. By initialing below this paragraph, I acknowledge that I understand the procedure of fitting me with an AFF or Tandem harness system and waive any claim which I might have against any of "The Released Parties", by reason of the same.

I Agree
 

16. COMPETENCY: I hereby certify and affirm that I am not now nor ever have been adjudicated incompetent in any court and further there is no guardian or person appointed by any court whose consent is required as a precondition of my knowing and willing waiver as herein provided. I am over the age of 18 and am not presently functioning under any legal, mental or physical incapacity.

I Agree

17. UNDERSTANDING OF AGREEMENT:  I understand that I may consult with an attorney of my choosing before entering into any agreement with AerOhio Skydiving, LLC. AerOhio Skydiving, LLC will provide upon my request a list of other companies providing like or similar services. I hereby certify that I have read and understand the contents of this document and wish to be bound by its items, terms and conditions. 

I Agree

18. I DO NOT HAVE TO SKYDIVE: I understand that I do not have to skydive and can change my mind at any time prior to placing my body outside of the aircraft exit door and choose not to jump. 

I Agree

19. I further acknowledge that I have been advised and recognize that my skydiving and parachuting activities are NOT COVERED BY ANY PERSONAL INJURY ACCIDENT INSURANCE OR GENERAL LIABILITY INSURANCE POLICY issued to "The Released Parties" and that it is a commonly known fact that this type of insurance is unavailable. 

I Agree

20. I acknowledge that each of "The Released Parties" involved in skydiving, parachuting, flying and related activities is an Independent Contractor. Each Released Entity is not responsible or liable for any acts, actions, negligence, errors, commissions, or omissions of any other Released Parties, or Independent Contractor. I AGREE TO HOLD EACH OF THE RELEASED PARTIES, OR INDEPENDENT CONTRACTORS HARMLESS FOR THE ACTIONS OF OTHERS. For the ease of accounting, I request that AerOhio Skydiving, LLC collect and distribute fees and charges that I owe to these Released Parties and Independent Contractors. 

I Agree

21. The terms of this Release, Waiver and Indemnity Agreement are contractual and not a mere recital, and contain the entire agreement between the parties hereto. It is hereby further agreed that any lawsuit arising out of this Agreement or my participation in skydiving activities, or any damages allegedly arising there from, shall be filed and maintained in the Common Pleas Court of Ashland County, Ohio. It is further agreed that in the event any lawsuit is filed in or removed to any court other than the Common Pleas Court of Ashland County, Ohio, including but not limited to any United States District Court, it shall be transferred to, or dismissed and re-filed in, said county on motion of and at the option of any of 'The Released Parties" released herein.

I Agree

22. I understand that the success of my jump(s) is dependent on the exact, proper, specific condition, quality, control, timing, performance, function, use, and maintenance of the equipment, aircraft, airspace, landing areas; along with the abilities, judgment, and experience of "The Released Parties." I understand that each of these individual components and parties cannot be depended upon to function properly or perfectly, and that each of them is subject to, but not limited to, the following possible conditions: active or passive SIMPLE NEGLIGENCE, GROSS NEGLIGENCE, OR ERROR; physical or mechanical malfunction with possible defects in design, manufacture, assembly, improper or careless use, wind, weather conditions, acts of nature or God, whether any of these above conditions, acts or risks are foreseen or unforeseen, contemplated or not contemplated, obvious or hidden, or through omission or commission. 

I Agree

23. I hereby give AerOhio Skydiving, LLC, Ohio Skydiving Center, and Wink’s Down to Earth Photography, Inc. permission to use any video or photographs taken of me or my party while participating in skydiving activities for advertising, promotional or other purposes. I specifically waive any interest proprietary or otherwise, I may have in such photographs and videos. 

I Agree

24. Warning: Parachuting and skydiving are exciting and challenging activities. However, THE RISK OF SERIOUS INJURY OR DEATH IS REAL and should not be overlooked or underestimated. DO NOT PARTICIPATE in these activities unless you voluntarily accept these risks. Each individual participant, regardless of experience, has final responsibility for his/her own safety. 

I Agree

25. LEGAL RIGHTS: I fully understand that by signing this document AND I UNDERSTAND THAT BY SIGNING THIS AGREEMENT I AM GIVING UP IMPORTANT LEGAL RIGHTS. I FULLY UNDERSTAND THE CONTENTS AND SIGN IT OF MY OWN FREE WILL. 

I Agree

The terms of this Release, Waiver and Indemnity Agreement are contractual and not a mere recital and contain the entire agreement between the parties hereto. I have carefully read this contract of agreement, release of liability, assumption of risk and agreement not to sue document. I fully understand its contents and sign it of my own free will.

I hereby certify and warrant that the statements contained above are true and correct to the best of my knowledge and belief. I further certify and understand that acceptance of this agreement by AerOhio Skydiving, LLC will be made on the basis of the statements contained above, and such accepted terms and conditions become part of this agreement between myself and AerOhio Skydiving, LLC to provide any services.

 

All Jumpers, including licensed skydivers, must complete the following section.

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


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.

In consideration of the Uninsured United Parachute Technologies, LLC, doing business as UPT Vector, and AerOhio Skydiving, 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:

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 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

6) 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; and (c) I do/do not (strike one) wear corrective lenses. 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

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 October 9, 2024.

 

IMPORTANT: Your name below MUST match your Burble account exactly.


First Jumper's Name

First Name*

Last Name*

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

Age:

Height:

Weight:
First Jumper's Signature*
Second Jumper's Name

First Name*

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

Age:

Height:

Weight:
Third Jumper's Name

First Name*

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

Age:

Height:

Weight:
Fourth Jumper's Name

First Name*

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

Age:

Height:

Weight:
Fifth Jumper's Name

First Name*

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

Age:

Height:

Weight:
Sixth Jumper's Name

First Name*

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

Age:

Height:

Weight:
Seventh Jumper's Name

First Name*

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

Age:

Height:

Weight:
Eighth Jumper's Name

First Name*

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

Age:

Height:

Weight:
Ninth Jumper's Name

First Name*

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

Age:

Height:

Weight:
Tenth Jumper's Name

First Name*

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

Age:

Height:

Weight:
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

First Name*

Last Name*

Emergency Contact's Phone Number*
Licensed Skydivers - USPA Membership

USPA Membership Number

USPA Expiration Date

USPA License Number

Total Number of Jumps
Ratings Held *
None
AFF I
Coach
Tandem I
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.


By signing below the parent or court-appointed legal guardian agrees that they are also 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

Age:

Height:

Weight:
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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