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Skydive Windy City

2019 Licensed Skydiver Waiver

Only Licensed Skydivers or STP students should complete this waiver

MEDICAL STATEMENT AND WAIVER

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.

STATEMENT OF MEDICAL FITNESS:

I, the participant, represent and warrant that I have no physical or mental infirmities, except as listed below; I am not under treatment for any physical or mental infirmity or chronic ailment or injury of any nature; I have never been treated for or diagnosed to have any of the following: cardiac or pulmonary conditions or diseases, diabetes, fainting spells or convulsions, nervous disorders, mental illness or depression, kidney problems or related diseases, high or low blood pressure, or any other disability which might in any way affect my ability to participate in skydiving, parachuting, flying, or other related activities.

WARNING! >> SKYDIVING, PARACHUTING, FLYING AND ALL RELATED ACTIVITIES ARE DANGEROUS AND THERE ARE RISKS INVOLVED WITH YOUR PARTICIPATION.

YOU CAN BE SERIOUSLY INJURED OR EVEN KILLED BY PARTICIPATION IN SKYDIVING, PARACHUTING, FLYING AND ALL RELATED ACTIVITIES. EACH INDIVIDUAL PARTICIPANT, REGARDLESS OF EXPERIENCE, HAS THE SOLE AND FINAL RESPONSIBILITY FOR HIS/HER OWN SAFETY. I FURTHER UNDERSTAND THERE IS NO LIABILITY INSURANCE AVAILABLE FOR SKYDIVING, PARACHUTING, FLYING AND ALL RELATED ACTIVITIES AS DEFINED IN THIS DOCUMENT AND ANY/ALL OTHER DOCUMENTS I MAY SIGN.

I will not skydive under the influence of alcohol in any form. I will not ingest any illegal substances within the 48 hours prior to skydiving. I will not take any prescription or non-prescription medicine that may affect my judgment or my ability to perform. I agree not to skydive under the influence of alcohol or any other drugs.

I have read the attached Agreement, Release of Liability and Assumption of Risk. I understand that it is a legal contract binding on me. I understand the document in its entirety. I intend to be bound by the document and understand that by signing the document I waive important legal rights.

I Agree

AGREEMENT, RELEASE OF LIABILITY, AND ASSUMPTION OF RISK

In consideration of Skdive Windy City allowing me to utilize the facilities and participate in the skydiving, freefall, parachuting, aviation, and/or other related activities (hereinafter referred to as "activities covered by the Agreement), I agree that:

1. ASSUMPTION OF RISK. I know and understand the scope, nature, and extent of the risks involved in the activities covered by this Agreement. I understand these risks include, but are not limited to: equipment malfunction and/or failure to function; defective and/or negligent design and/or manufacture of equipment; improper and/or negligent parachute packing and/or assembly; improper and/or negligent operation and/or use of the equipment; aircraft malfunction and/or negligent aircraft operation; carelessness and/or negligent instruction and/or supervision. I voluntarily, freely and expressly choose to incur all risks associated with the activities covered by this Agreement, understanding that those risks may include personal injury, damage to property, and/or death.

2. EXEMPTION(S) AND RELEASE FROM LIABILITY. I exempt and release the following persons, corporations, and organizations: Sky Sports, Inc., dba Skydive Windy City and any of its employees or contractors. Any and all equipment manufacturers, vendors, suppliers, repair facilities or repair persons, any and all aircraft owners, any and all pilots with whom it contracts for flying services; the United States Parachute Association (USPA); the City of Michigan City Indiana, the Michigan City Municipal Airport, the Michigan City Board of Aviation Commissioners (BOAC): and including all of each person's, corporations, and organization's officers, agents, servants, employees, representatives, lessors; (hereinafter collectively referred to as Releasees), 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, while upon the premises or aircraft or while participating in any of the activities covered by this Agreement, whether resulting from the negligence and/or other fault, either active or passive, of any of Releasees, or from any other cause

3. COVENANTS NOT TO SUE. I agree never to institute any suit or action at law or otherwise against any of Releasees, 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 other fault, either active or passive, of any of Releasees, or from any other cause. 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 Releasees, nor shall they initiate or assist the prosecution of any claim for damages or 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, arising from activities covered by this Agreement, whether caused by the negligence and for other fault, either active or passive, of any of Releasees, 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 such suit or action at law or otherwise be instituted against any of Releasees, I agree that such Releasees shall be entitled to recover attorneys' fees and costs incurred in defense of such suit or action, including any appeals there from.

4. INDEMNITY AGAINST THIRD PARTY CLAIMS. I will indemnify, save and hold harmless Releasees from any and all losses, claims, actions, or proceedings of every kind and character, including attorney's fees and expenses, which may be presented or initiated by any other persons or organizations and which arise directly or indirectly from my participation in the activities covered by this Agreement, whether resulting from the negligence and/or other fault, either active or passive, of any of Releasees or from any other cause.

5. VALIDITY OF WAIVER. I understand and agree 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 Releasees 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 as evidence in court, and that agreements like this one have been upheld in courts in similar circumstances.

6. REPRESENTATIONS AND WARRANTIES. 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 of the following: cardiac or pulmonary conditions or disease, 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) If I am prescribed corrective lenses, I agree to wear them during my intentional parachute jump.

7. APPLICABLE LAW/WAIVER OF JURY TRIAL/VENUE/HEADINGS. I agree that the laws of the State of Indiana shall apply to issues involving the construction, interpretation, and validity of this Agreement and that Indiana law shall govern any dispute between the parties arising from the activities contemplated by this Agreement. Should this Agreement be violated and suit be brought against any of Releasees, my right to a jury trial is waived, and LaPorte County, Indiana shall be the venue for any such suit. I agree that the headings and subheadings used throughout this Agreement are for convenience only and have no significance in the interpretation of the body of this Agreement.

8. SEVERABILITY. 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.

9. LIFT RATES / EQUIPMENT RENTAL / PHOTO RIGHTS. I agree to pay the published rates as on the website and/or at manifest for each lift. I agree to pay the published rates as on the website and/or at manifest for any/all rental equipment I use. I agree to exercise due diligence for the operation and/or care of any/all equipment I rent or borrow from Skydive Windy City or its agents/designees, and that I may be held financially responsible for damage to and/or loss of rented or borrowed equipment. I agree to allow all photos and/or video taken while at Skydive Windy City to be used by any of Releasees.

10. CONTINUATION OF OBLIGATIONS. I agree and acknowledge that the terms and conditions of this 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 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.

11. ACKNOWLEDGEMENT. I hereby acknowledge that I have read all of the provisions above and fully understand the terms and conditions expressed therein and agree to be bound by such terms and conditions.

12. MY PERFORMANCE.  I agree to keep my USPA membership current at all times and to inform Skydive Windy City immediately if my membership is not current.  I agree to maintain any and all skydiving parachute systems I may use (other than those rented or borrowed from Skydive Windy City) according to FAR part 105, and inform Skydive Windy City immediately if any system I use or plan to use is not maintained according to Federal Aviation Regulations.  I agree to follow all applicable Federal Aviation Regulations, USPA BSRs, and dropzone rules at all times.

I Agree

First Skydiver Name

First Name*

Middle Name

Last Name*

Phone*
First Skydiver Date of Birth*
First Skydiver Information

USPA (or other entity) Membership Number (returning STP students enter "STUDENT") *

Height/Weight *
First Skydiver Signature*
Second Skydiver Name

First Name*

Middle Name

Last Name*
Second Skydiver Date of Birth*
Second Skydiver Information

USPA (or other entity) Membership Number (returning STP students enter "STUDENT") *

Height/Weight *
Third Skydiver Name

First Name*

Middle Name

Last Name*
Third Skydiver Date of Birth*
Third Skydiver Information

USPA (or other entity) Membership Number (returning STP students enter "STUDENT") *

Height/Weight *
Fourth Skydiver Name

First Name*

Middle Name

Last Name*
Fourth Skydiver Date of Birth*
Fourth Skydiver Information

USPA (or other entity) Membership Number (returning STP students enter "STUDENT") *

Height/Weight *
Fifth Skydiver Name

First Name*

Middle Name

Last Name*
Fifth Skydiver Date of Birth*
Fifth Skydiver Information

USPA (or other entity) Membership Number (returning STP students enter "STUDENT") *

Height/Weight *
Sixth Skydiver Name

First Name*

Middle Name

Last Name*
Sixth Skydiver Date of Birth*
Sixth Skydiver Information

USPA (or other entity) Membership Number (returning STP students enter "STUDENT") *

Height/Weight *
Seventh Skydiver Name

First Name*

Middle Name

Last Name*
Seventh Skydiver Date of Birth*
Seventh Skydiver Information

USPA (or other entity) Membership Number (returning STP students enter "STUDENT") *

Height/Weight *
Eighth Skydiver Name

First Name*

Middle Name

Last Name*
Eighth Skydiver Date of Birth*
Eighth Skydiver Information

USPA (or other entity) Membership Number (returning STP students enter "STUDENT") *

Height/Weight *
Ninth Skydiver Name

First Name*

Middle Name

Last Name*
Ninth Skydiver Date of Birth*
Ninth Skydiver Information

USPA (or other entity) Membership Number (returning STP students enter "STUDENT") *

Height/Weight *
Tenth Skydiver Name

First Name*

Middle Name

Last Name*
Tenth Skydiver Date of Birth*
Tenth Skydiver Information

USPA (or other entity) Membership Number (returning STP students enter "STUDENT") *

Height/Weight *
Skydiver 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*
INFIRMITIES OR EXCEPTIONS

If you have any infirmities, exceptions, or medical conditions that require special attention or affect/may affect the safety of your skydive, list them here (do not enter anything if you have none)

Emergency Contact 2 Name (optional)

Emergency Contact 2 Phone Number (optional)
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

USPA (or other entity) Membership Number (returning STP students enter "STUDENT") *

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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