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Skydive Moab

WARNING!

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

Please note: After viewing the instructional tape and signing this waiver you are electing to make a skydive. Please realize that skydiving is a weather dependent sport and we will try to jump with you as soon as possible.  If you do not get to jump today, you may have to reschedule for another time.  You may get a partial refund at any time before you suit up.

The $50 deposit is only refundable if you cancel within 48 hours of the jump or if we cancel the jump for bad weather. The waiver video states you can get a full refund before you suit up, which is true but minus the $50 deposit per person.

 

SKYDIVE MOAB, LLC AND SKYDIVE NEW HAMPSHIRE, LLC - Utah Release Form

THE UNDERLYING DOCUMENT IS A "WAIVER", AN "ASSUMPTION OF RISK AGREEMENT" AND A "RELEASE OF LIABILITY".  READ IT CAREFULLY!
SIGNING THIS DOCUMENT DRASTICALLY AFFECTS YOUR LEGAL RIGHTS.
Skydiving is a dangerous sport!
There is no way to eliminate the possibility of serious injury or death.

AGREEMENT AND RELEASE OF LIABILITY

In consideration for being permitted to use the facilities of SKYDIVE MOAB, LLC and SKYDIVE NEW HAMPSHIRE, LLC, and more generally, the facilities and equipment located at the Grand County Utah and Canyonlands Regional Airport, North Hwy 191, Moab, Utah, and to engage in parachute jumping, ground instruction, flying and all related activities (Hereinafter referred to as "Parachuting Activities"),

I hereby agree to the following:

1. I HEREBY RELEASE AND DISCHARGE SKYDIVE MOAB, LLC, SKYDIVE NEW HAMPSHIRE, LLC, UNITED STATES PARACHUTE ASSOCIATION (USPA)­ AND MANUFACTURERS, DISTRIBUTORS AND DEALERS OF SKYDIVING EQUIPMENT, SORREL RIVER RANCH, CASTLE VALLEY INC (DBA DAYSTAR ADVENTIST ACADEMY AND CASTLE VALLEY FARMS),  BUREAU OF LAND MANAGEMENT, SKYDIVE ARIZONA, CLINT MACBETH, KEITH MACBETH, THEIR AGENTS, EMPLOYEES, INDEPENDANT CONTRACTORS, INSTRUCTORS, JUMP MASTERS, PARACHUTE PACKERS, PARACHUTE RIGGERS, PILOTS USED FOR THE PARACHUTING ACTIVITIES AS WELL AS THE CANYONLANDS REGIONAL AIRPORT AND GRAND COUNTY UTAH (Hereinafter referred to as the “RELEASED PARTIES"), FROM ANY AND ALL LIABILITY, CLAIMS, DEMANDS AND CAUSES OF ACTION FOR INJURIES AND DAMAGES ARISING FROM MY PARTICIPATION IN PARACHUTING ACTIVITIES, INCLUDING BUT NOT LIMITED TO LOSSES CAUSED BY THE  NEGLIGIENCE OF THE RELEASED PARTIES. 

I Agree

2. I further agree that I WILL NOT SUE OR MAKE A CLAIM against the Released Parties for damages or other losses sustained as a result of my participation in Parachuting Activities.

I Agree

3. I also agree to INDEMNIFY AND HOLD THE RELEASED PARTIES HARMLESS from all claims, judgments, and costs, including attorneys' fees, incurred in the connection with any action brought as a result in my participation in Parachuting Activities, including actions based on the negligence of the Released Parties.

I Agree

4. 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 OF PERSONAL INJURY OR DEATH SUSTAINED WHILE PARTICIPATING IN PARACHUTING ACTIVITIES WHETHER OR NOT CAUSED BY THE NEGLIGENCE OF THE RELEASED PARTIES.

I Agree

5. I have been advised and recognize that my Parachuting Activities are NOT COVERED by any personal accident or general liability insurance policy issued to the Released Parties.

I Agree

6. I agree that any action arising out of my Parachuting Activities are filed in the state of Utah.

I Agree

    ***************************Please Read Carefully*****************************

7.    I realize that I can opt to stop after reading this form and get a full refund. I can choose to:

a)    NOT Skydive and get a refund.
b)    SKYDIVE and assume the risk. 

8. I certify that I have watched the video introduction explaining the risks of making a skydive and parachute jump which has further explained the information contained in these documents.

I Agree

9. I do not hold the Released Parties responsible for damage or loss of my property while with SKYDIVE  MOAB, LLC and SKYDIVE NEW HAMPSHIRE, LLC and CANYONLANDS REGIONAL AIRPORT and GRAND COUNTY UTAH.   

I Agree

10. I hereby grant the Released Parties and their designees my consent to create video and audio recordings of me and to take photographs of me (both in the air and on the ground) (“Recordings”).  I understand that the Recordings may be used for any purpose (including, among others, advertising, promotion and marketing products or services).  I grant permission to the Released Parties, their designees, their sponsors, and their successors and assignors to use my appearance, name, voice, and likeness (at their election) in connection with the Recordings and in any and all manner and media throughout the world in perpetuity.  I agree that the Recordings may be combined with other images, text, and graphics, and may be cropped, altered or modified.   

I Agree

11. I HAVE CAREFULLY READ AND INITIALED THIS AGREEMENT & RELEASE OF LIABILITY, AND CERTIFY THAT I FULLY UNDERSTAND IT. I AM SIGNING THIS AGREEMENT & RELEASE OF LIABILITY OF MY OWN FREE WILL.May 18, 2024

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. 

I Agree

In consideration of the Uninsured United Parachute Technologies, LLC, doing business as UPT Vector, and Skydive Moab, 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 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 Uninsured United Parachute Technologies, LLC TANDEM PARACHUTE JUMPER AGREEMENT 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.

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 the day of May 18, 2024 at Skydive Moab.

 

MEDICAL STATEMENT

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 and Jumping.

I further certify that I have not consumed any Alcoholic Beverages or Drugs within the last eight (8) hours now and before any jumping activity. I also recognize that it is against Federal, State, United States Parachute Association, SKYDIVE MOAB, LLC and SKYDIVE NEW HAMPSHIRE, LLC and Utah Rules and Regulations to ingest either Alcohol or Drugs while engaging in Parachuting Activities and agree to refrain from doing so.

                                                             

I certify that I am at least eighteen years of age and have shown proof of my age by State ID, driver's license, or valid passport.

 

If there are any physical/mental issues that may effect you skydive, please inform Skydive Moab prior to your reservation.

If you wear corrective glasses or contacts, please let your instructor know. Additionally Skydive Moab or its staff members are not responsible for lost eyewear.

Parent or Guardian's Driver's License / ID Card

Driver's License / ID Card Number*

Issuing State*
First Tandem Students Name

First Name*

Last Name*

Phone*
First Tandem Students Date of Birth*
First Tandem Students Information
I realize that I can opt to stop after reading this form and get a full refund. I choose to:*
Check Boxes IF you ARE under the treatment for any of the following conditions:
Cardiac or Pulmonary Condition Disease
High or Low Blood Pressure
Fainting Spells or Convulsions
Hearing Loss or Impairment
Nervous Disorders
Diabetes
Kidney or Related Diseases
Shortness of Breath
Psychiatric Disorders
So... how did you hear about us? *
SkydiveMoab.com
Google Search
Facebook/Instagram
Other website
Billboards/Signs in Moab
Skydive Moab vehicle
Hotel Room Info Booklet
Moab Guest Guide ad
Rack Cards in Moab
A Friend Jumped Before
Other Word of Mouth
Redcliffs Lodge TV

If Other:
And... what brought you to Moab? *
Skydiving
ATV or Dirt Bike
Jeeping
National Parks
Camping
Hiking Trails
Rock Climbing
Canyoneering
Scenic Views/Photos
Rafting
Friends/family
Already live here
Mountain Biking

If Other:
First Tandem Students Signature*
Second Tandem Students Name

First Name*

Last Name*
Second Tandem Students Date of Birth*
Second Tandem Students Information
I realize that I can opt to stop after reading this form and get a full refund. I choose to:*
Check Boxes IF you ARE under the treatment for any of the following conditions:
Cardiac or Pulmonary Condition Disease
High or Low Blood Pressure
Fainting Spells or Convulsions
Hearing Loss or Impairment
Nervous Disorders
Diabetes
Kidney or Related Diseases
Shortness of Breath
Psychiatric Disorders
So... how did you hear about us? *
SkydiveMoab.com
Google Search
Facebook/Instagram
Other website
Billboards/Signs in Moab
Skydive Moab vehicle
Hotel Room Info Booklet
Moab Guest Guide ad
Rack Cards in Moab
A Friend Jumped Before
Other Word of Mouth
Redcliffs Lodge TV

If Other:
And... what brought you to Moab? *
Skydiving
ATV or Dirt Bike
Jeeping
National Parks
Camping
Hiking Trails
Rock Climbing
Canyoneering
Scenic Views/Photos
Rafting
Friends/family
Already live here
Mountain Biking

If Other:
Third Tandem Students Name

First Name*

Last Name*
Third Tandem Students Date of Birth*
Third Tandem Students Information
I realize that I can opt to stop after reading this form and get a full refund. I choose to:*
Check Boxes IF you ARE under the treatment for any of the following conditions:
Cardiac or Pulmonary Condition Disease
High or Low Blood Pressure
Fainting Spells or Convulsions
Hearing Loss or Impairment
Nervous Disorders
Diabetes
Kidney or Related Diseases
Shortness of Breath
Psychiatric Disorders
So... how did you hear about us? *
SkydiveMoab.com
Google Search
Facebook/Instagram
Other website
Billboards/Signs in Moab
Skydive Moab vehicle
Hotel Room Info Booklet
Moab Guest Guide ad
Rack Cards in Moab
A Friend Jumped Before
Other Word of Mouth
Redcliffs Lodge TV

If Other:
And... what brought you to Moab? *
Skydiving
ATV or Dirt Bike
Jeeping
National Parks
Camping
Hiking Trails
Rock Climbing
Canyoneering
Scenic Views/Photos
Rafting
Friends/family
Already live here
Mountain Biking

If Other:
Fourth Tandem Students Name

First Name*

Last Name*
Fourth Tandem Students Date of Birth*
Fourth Tandem Students Information
I realize that I can opt to stop after reading this form and get a full refund. I choose to:*
Check Boxes IF you ARE under the treatment for any of the following conditions:
Cardiac or Pulmonary Condition Disease
High or Low Blood Pressure
Fainting Spells or Convulsions
Hearing Loss or Impairment
Nervous Disorders
Diabetes
Kidney or Related Diseases
Shortness of Breath
Psychiatric Disorders
So... how did you hear about us? *
SkydiveMoab.com
Google Search
Facebook/Instagram
Other website
Billboards/Signs in Moab
Skydive Moab vehicle
Hotel Room Info Booklet
Moab Guest Guide ad
Rack Cards in Moab
A Friend Jumped Before
Other Word of Mouth
Redcliffs Lodge TV

If Other:
And... what brought you to Moab? *
Skydiving
ATV or Dirt Bike
Jeeping
National Parks
Camping
Hiking Trails
Rock Climbing
Canyoneering
Scenic Views/Photos
Rafting
Friends/family
Already live here
Mountain Biking

If Other:
Fifth Tandem Students Name

First Name*

Last Name*
Fifth Tandem Students Date of Birth*
Fifth Tandem Students Information
I realize that I can opt to stop after reading this form and get a full refund. I choose to:*
Check Boxes IF you ARE under the treatment for any of the following conditions:
Cardiac or Pulmonary Condition Disease
High or Low Blood Pressure
Fainting Spells or Convulsions
Hearing Loss or Impairment
Nervous Disorders
Diabetes
Kidney or Related Diseases
Shortness of Breath
Psychiatric Disorders
So... how did you hear about us? *
SkydiveMoab.com
Google Search
Facebook/Instagram
Other website
Billboards/Signs in Moab
Skydive Moab vehicle
Hotel Room Info Booklet
Moab Guest Guide ad
Rack Cards in Moab
A Friend Jumped Before
Other Word of Mouth
Redcliffs Lodge TV

If Other:
And... what brought you to Moab? *
Skydiving
ATV or Dirt Bike
Jeeping
National Parks
Camping
Hiking Trails
Rock Climbing
Canyoneering
Scenic Views/Photos
Rafting
Friends/family
Already live here
Mountain Biking

If Other:
Sixth Tandem Students Name

First Name*

Last Name*
Sixth Tandem Students Date of Birth*
Sixth Tandem Students Information
I realize that I can opt to stop after reading this form and get a full refund. I choose to:*
Check Boxes IF you ARE under the treatment for any of the following conditions:
Cardiac or Pulmonary Condition Disease
High or Low Blood Pressure
Fainting Spells or Convulsions
Hearing Loss or Impairment
Nervous Disorders
Diabetes
Kidney or Related Diseases
Shortness of Breath
Psychiatric Disorders
So... how did you hear about us? *
SkydiveMoab.com
Google Search
Facebook/Instagram
Other website
Billboards/Signs in Moab
Skydive Moab vehicle
Hotel Room Info Booklet
Moab Guest Guide ad
Rack Cards in Moab
A Friend Jumped Before
Other Word of Mouth
Redcliffs Lodge TV

If Other:
And... what brought you to Moab? *
Skydiving
ATV or Dirt Bike
Jeeping
National Parks
Camping
Hiking Trails
Rock Climbing
Canyoneering
Scenic Views/Photos
Rafting
Friends/family
Already live here
Mountain Biking

If Other:
Seventh Tandem Students Name

First Name*

Last Name*
Seventh Tandem Students Date of Birth*
Seventh Tandem Students Information
I realize that I can opt to stop after reading this form and get a full refund. I choose to:*
Check Boxes IF you ARE under the treatment for any of the following conditions:
Cardiac or Pulmonary Condition Disease
High or Low Blood Pressure
Fainting Spells or Convulsions
Hearing Loss or Impairment
Nervous Disorders
Diabetes
Kidney or Related Diseases
Shortness of Breath
Psychiatric Disorders
So... how did you hear about us? *
SkydiveMoab.com
Google Search
Facebook/Instagram
Other website
Billboards/Signs in Moab
Skydive Moab vehicle
Hotel Room Info Booklet
Moab Guest Guide ad
Rack Cards in Moab
A Friend Jumped Before
Other Word of Mouth
Redcliffs Lodge TV

If Other:
And... what brought you to Moab? *
Skydiving
ATV or Dirt Bike
Jeeping
National Parks
Camping
Hiking Trails
Rock Climbing
Canyoneering
Scenic Views/Photos
Rafting
Friends/family
Already live here
Mountain Biking

If Other:
Eighth Tandem Students Name

First Name*

Last Name*
Eighth Tandem Students Date of Birth*
Eighth Tandem Students Information
I realize that I can opt to stop after reading this form and get a full refund. I choose to:*
Check Boxes IF you ARE under the treatment for any of the following conditions:
Cardiac or Pulmonary Condition Disease
High or Low Blood Pressure
Fainting Spells or Convulsions
Hearing Loss or Impairment
Nervous Disorders
Diabetes
Kidney or Related Diseases
Shortness of Breath
Psychiatric Disorders
So... how did you hear about us? *
SkydiveMoab.com
Google Search
Facebook/Instagram
Other website
Billboards/Signs in Moab
Skydive Moab vehicle
Hotel Room Info Booklet
Moab Guest Guide ad
Rack Cards in Moab
A Friend Jumped Before
Other Word of Mouth
Redcliffs Lodge TV

If Other:
And... what brought you to Moab? *
Skydiving
ATV or Dirt Bike
Jeeping
National Parks
Camping
Hiking Trails
Rock Climbing
Canyoneering
Scenic Views/Photos
Rafting
Friends/family
Already live here
Mountain Biking

If Other:
Ninth Tandem Students Name

First Name*

Last Name*
Ninth Tandem Students Date of Birth*
Ninth Tandem Students Information
I realize that I can opt to stop after reading this form and get a full refund. I choose to:*
Check Boxes IF you ARE under the treatment for any of the following conditions:
Cardiac or Pulmonary Condition Disease
High or Low Blood Pressure
Fainting Spells or Convulsions
Hearing Loss or Impairment
Nervous Disorders
Diabetes
Kidney or Related Diseases
Shortness of Breath
Psychiatric Disorders
So... how did you hear about us? *
SkydiveMoab.com
Google Search
Facebook/Instagram
Other website
Billboards/Signs in Moab
Skydive Moab vehicle
Hotel Room Info Booklet
Moab Guest Guide ad
Rack Cards in Moab
A Friend Jumped Before
Other Word of Mouth
Redcliffs Lodge TV

If Other:
And... what brought you to Moab? *
Skydiving
ATV or Dirt Bike
Jeeping
National Parks
Camping
Hiking Trails
Rock Climbing
Canyoneering
Scenic Views/Photos
Rafting
Friends/family
Already live here
Mountain Biking

If Other:
Tenth Tandem Students Name

First Name*

Last Name*
Tenth Tandem Students Date of Birth*
Tenth Tandem Students Information
I realize that I can opt to stop after reading this form and get a full refund. I choose to:*
Check Boxes IF you ARE under the treatment for any of the following conditions:
Cardiac or Pulmonary Condition Disease
High or Low Blood Pressure
Fainting Spells or Convulsions
Hearing Loss or Impairment
Nervous Disorders
Diabetes
Kidney or Related Diseases
Shortness of Breath
Psychiatric Disorders
So... how did you hear about us? *
SkydiveMoab.com
Google Search
Facebook/Instagram
Other website
Billboards/Signs in Moab
Skydive Moab vehicle
Hotel Room Info Booklet
Moab Guest Guide ad
Rack Cards in Moab
A Friend Jumped Before
Other Word of Mouth
Redcliffs Lodge TV

If Other:
And... what brought you to Moab? *
Skydiving
ATV or Dirt Bike
Jeeping
National Parks
Camping
Hiking Trails
Rock Climbing
Canyoneering
Scenic Views/Photos
Rafting
Friends/family
Already live here
Mountain Biking

If Other:
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*
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
I realize that I can opt to stop after reading this form and get a full refund. I choose to:*
Check Boxes IF you ARE under the treatment for any of the following conditions:
Cardiac or Pulmonary Condition Disease
High or Low Blood Pressure
Fainting Spells or Convulsions
Hearing Loss or Impairment
Nervous Disorders
Diabetes
Kidney or Related Diseases
Shortness of Breath
Psychiatric Disorders
So... how did you hear about us? *
SkydiveMoab.com
Google Search
Facebook/Instagram
Other website
Billboards/Signs in Moab
Skydive Moab vehicle
Hotel Room Info Booklet
Moab Guest Guide ad
Rack Cards in Moab
A Friend Jumped Before
Other Word of Mouth
Redcliffs Lodge TV

If Other:
And... what brought you to Moab? *
Skydiving
ATV or Dirt Bike
Jeeping
National Parks
Camping
Hiking Trails
Rock Climbing
Canyoneering
Scenic Views/Photos
Rafting
Friends/family
Already live here
Mountain Biking

If Other:
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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