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Alberta Skydive Central Ltd
3 - 1041 HWY 54
Red Deer County, AB 
T4G 0H6

 

Medical Disclaimer Waiver

AGREEMENT, RELEASE OF LIABILITY AND ASSUMPTION OF RISK 

IN CONSIDERATION of being permitted to utilize the facilities and equipment of Alberta Skydive Central Ltd., (and its associated entities, including but not limited to, Okanagan Air Ventures LTD.), to engage in parachute activities, 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 Alberta Skydive Central., and its agents, associated entities, officers, shareholders, partners, employees, pilots, instructors, coaches, jumpmasters, the owners of all aircraft used in parachuting activities including but not limited to, N Air Aviation Ltd. and Okanagan Air Ventures LTD, and the owners and lessees of any and all lands utilized for "parachuting activities", the Canadian Sport Parachuting Association and its members, the United States Parachute Association and its members, anyone working with or for Alberta Skydive Central Ltd., and anyone involved in my "parachuting activities", herein collectively referred to in this Agreement, Release of Liability and Assumption of Risk as Alberta Skydive Central Ltd.

  2. RISKS CONTEMPLATED: This Agreement is made in contemplation of all "parachuting activities", including but not limited to parachute jumping, ground instruction, flying and related activities, the exit, freefall, time under canopy, the landing, any rescue operations or attempts by Alberta Skydive Central Ltd. whether on, above or over the area known at the Alberta Skydive Central Innisfail Airport, Innisfail, AB or Westlock Airport, Westlock, AB, or or any facilities used by Alberta Skydive Central Ltd.

  3. RELEASE FROM LIABILITY: I hereby release and discharge Alberta Skydive Central Ltd. from any and all liability, claims, demands, or causes or action that I may hereafter have for injuries or damages arising out of my participation in "parachuting activities" even if caused by negligence or any other fault of Alberta Skydive Central Ltd.

  4. COVENANT NOT TO SUE: I further agree that I WILL NOT SUE OR MAKE CLAIM against Alberta Skydive Central Ltd. for damages or other losses sustained as a result of my participation in "parachuting activities" even if caused by negligence or other fault of Alberta Skydive Central Ltd.

  5. INDEMNIFICATION AND HOLD HARMLESS: I also agree to INDEMNIFY AND HOLD Alberta Skydive Central Ltd. HARMLESS from all claims, judgements and costs, including but not limited to solicitor costs, and to reimburse them for any expense whatsoever incurred in connection with any action brought as a result of my participation in "parachuting activities.”

  6. ASSUMPTION OF RISK: I understand and acknowledge that "parachuting activities" are inherently dangerous and I EXPRESSLY AND VOLUNTARILY ASSUME ANY AND ALL RISKS OF DEATH OR PERSONAL INJURY SUSTAINED WHILE PARTICIPATING IN "PARACHUTING ACTIVITIES" WHETHER OR NOT SUCH BE CAUSED BY THE NEGLIGENCE OR OTHER FAULT OF ALBERTA SKYDIVE CENTRAL LTD.  including but not limited to equipment malfunction however caused, inadequate training, any and all deficiencies in the landing area, rescue attempts, bad landings and any other injury I may sustain even if it be caused by any negligence or fault of Alberta Skydive Central Ltd.

  7. PARTIES BOUND BY THIS AGREEMENT: It is my understanding and intent that this Agreement, Release of Liability and Assumption of Risk be binding, not only by myself, but on any other person or entity, including, but not limited to my estate and my heirs who or that may be able to or do sue because of my injury or death. It is furthermore my understanding and agreement that this Release is intended to and does in fact release Alberta Skydive Central Ltd. from any and all claims or obligations whatsoever arising in any way from my participation in "parachuting activities", even if such be caused by negligence or any other fault. 

  8. LIMITATION OF WARRANTY: Alberta Skydive Central Ltd. hereby warrants that the equipment provided by Alberta Skydive Central Ltd. has been previously used for "parachuting activities”. This warranty is the only warranty made and is made in lieu of any other warranties, expressed or implied, including but not limited to warrant of merchantability or fitness for a particular purpose. I have read the above paragraph, acknowledge that I understand it and accept the limitations, actual and implied, of warranty.

  9. DURATION OF RELEASE: It is my understanding and intention that this Release and Agreement be effective, not only for my first jump, but for any subsequent jumps or activities in anyway associated with Alberta Skydive Central Ltd. 

  10. ENFORCEABILITY: I agree that if any portions of this Agreement, Release of Liability and Assumption of Risk are found to be unenforceable or against public policy, that only that portion shall fail, but I specifically waive any unenforceability or any public argument that I personally may make or that may be made on behalf of myself or my estate by anyone who would cause suit to be brought forth as a result of my injury or death. 

  11. LEGAL RIGHTS: It has been explained to me and I understand that by signing this document, I am giving up important legal rights and it is my intention to do so. 

  12. I AGREE that any photographs and/or video taken by Alberta Skydive Central Ltd. remain the property of Alberta Skydive Central Ltd. and may be used for any purpose they deem fit. 

  13. UNDERSTANDING, BINDING AND AGREEMENT THERETO. I hereby certify that I have read and understand the contents of this document and I wish to be bound by its terms. 

Fill out the waiver by scanning Your Driver's License

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First Participant's Name

First Name*

Last Name*

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

Height(Inches): *

Weight(lbs): *

MEDICAL STATEMENT FOR UNDERGOING PARACHUTE TRAINING AND JUMPING 

I hereby certify that I am not aware of and am not under treatment for any physical infirmity or chronic ailment or injury of any nature, and that I have normal vision or have corrective lenses, and that I have never been treated for any of the following: Epilepsy (even if well controlled by drugs), Severe Diabetes (which is poorly controlled), Drug Addiction Or Alcoholism, Total Deafness or Exceeding Bad Hearing, Dislocation of the Shoulder, Marked Obesity, Large Inguinal Hernia, Hemophilia, Abnormal Stress ECG, Severe Asthmatics, Cardiac or Pulmonary Condition, High or Low Blood Pressure, Fainting Spells, Convulsions. Nervous Disorder, Kidney or Related Diseases or any other medical condition that may affect or impair my ability to skydive safely.*
Yes, I am in good medical condition and do not have any of the conditions above.
No, I am not in good medical condition. I have a medical condition listed above that may prevent me from participating in "parachuting activities".
Please check all conditions that you experience or have been diagnosed.
Epilepsy (even if well controlled by drugs)
Severe Diabetes (which is poorly controlled)
Drug Addiction Or Alcoholism
Total Deafness or Exceeding Bad Hearing
Dislocation of the Shoulder
Marked Obesity
Large Inguinal Hernia
Hemophilia
Abnormal Stress ECG
Severe Asthmatics
Cardiac or Pulmonary Condition
High or Low Blood Pressure
Fainting Spells
Convulsions
Nervous Disorder
Kidney or Related Diseases
Any other medical condition that may affect or impair my ability to skydive safely
Are you on medication of ANY kind (prescription or otherwise) at the present time?*
Yes
No

If "YES", please specify medication(s).

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 application by Alberta Skydive Central Ltd will be made on the basis of the statements contained above, and such accepted application will become part of the agreement between myself and Alberta Skydive Central Ltd to provide this service.


(Town/City, Province) ,This waiver was completed and signed *
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*
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Your signed waiver will be sent to the email address provided here and is available for download for three days via URL attachment.
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 16 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*

Relationship*

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

Height(Inches): *

Weight(lbs): *

MEDICAL STATEMENT FOR UNDERGOING PARACHUTE TRAINING AND JUMPING 

I hereby certify that I am not aware of and am not under treatment for any physical infirmity or chronic ailment or injury of any nature, and that I have normal vision or have corrective lenses, and that I have never been treated for any of the following: Epilepsy (even if well controlled by drugs), Severe Diabetes (which is poorly controlled), Drug Addiction Or Alcoholism, Total Deafness or Exceeding Bad Hearing, Dislocation of the Shoulder, Marked Obesity, Large Inguinal Hernia, Hemophilia, Abnormal Stress ECG, Severe Asthmatics, Cardiac or Pulmonary Condition, High or Low Blood Pressure, Fainting Spells, Convulsions. Nervous Disorder, Kidney or Related Diseases or any other medical condition that may affect or impair my ability to skydive safely.*
Yes, I am in good medical condition and do not have any of the conditions above.
No, I am not in good medical condition. I have a medical condition listed above that may prevent me from participating in "parachuting activities".
Please check all conditions that you experience or have been diagnosed.
Epilepsy (even if well controlled by drugs)
Severe Diabetes (which is poorly controlled)
Drug Addiction Or Alcoholism
Total Deafness or Exceeding Bad Hearing
Dislocation of the Shoulder
Marked Obesity
Large Inguinal Hernia
Hemophilia
Abnormal Stress ECG
Severe Asthmatics
Cardiac or Pulmonary Condition
High or Low Blood Pressure
Fainting Spells
Convulsions
Nervous Disorder
Kidney or Related Diseases
Any other medical condition that may affect or impair my ability to skydive safely
Are you on medication of ANY kind (prescription or otherwise) at the present time?*
Yes
No

If "YES", please specify medication(s).

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 application by Alberta Skydive Central Ltd will be made on the basis of the statements contained above, and such accepted application will become part of the agreement between myself and Alberta Skydive Central Ltd to provide this service.


(Town/City, Province) ,This waiver was completed and signed *
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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