Loading...

SKYDIVE MESQUITE, LLC
(referred to hereinafter as SKYDIVE MESQUITE)

ACKNOWLEDGMENT OF RISKS, ASSUMPTION OF RISK AND RESPONSIBILITY AND RELEASE OF LIABILITY

WARNING: There are significant elements of risk and danger inherent in participation in sport parachuting and skydiving (referred to herein as the or this “activity”) which can result in serious injury and/or death.

ACKNOWLEDGMENT OF RISKS: I hereby acknowledge and recognize the risks and dangers inherent in this activity. These risks may result in serious personal injury or death, and include but are not limited to the following: 1) Falls during parachute jumps, skydiving or during the ascent or descent; 2) Cold weather related injuries including hypothermia, frostnip and frostbite which may result in loss of limbs, digits, and/or permanent scarring; 3) Heat related illnesses including heat exhaustion and heat stroke; 4) Altitude related sicknesses; 5) An “act of nature” which may include inclement weather, varied or severe wind, temperature or weather conditions; 6) Ground and air travel to or from the activity; 7) Equipment, vehicle, aircraft or parachute malfunction or failure; and 8) other accidents arising out of or occurring during instruction, training or participation in this activity. I also acknowledge that certain foreseeable and unforeseeable events can contribute to the unpredictability of the activity; that personal property may be damaged or lost; that I may suffer accidents or illnesses in places where there are no available medical facilities; and, that wearing appropriate clothing, and footwear as well as maintaining my own equipment in accordance with FAA regulations is my own responsibility, and may be basic safety precautions. I acknowledge and warrant that I am in good health, and that my physical health will not interfere with my participation in the activity.

EXPRESS ASSUMPTION OF RISK AND RESPONSIBILITY: In recognition of the inherent risks of this type of activity which I and any minor children for which I am responsible, will engage in, I confirm that I am (we are) physically and mentally capable of participating in the activity and/or using equipment. I/we participate willingly and voluntarily and I assume full responsibility for personal injury, accidents or illness (including death), and any expenses as a result of my negligence or the negligence of any minor children for which I am responsible. I also assume responsibility for damage to or loss of personal property as the result of any accident that may occur.

I assume the risk(s) that my participation in this type of activity may involve bodily and/or emotional injury, including but not limited to personal injury, accidents and/or illness, including but not limited to sprains, torn muscles and/or ligaments; fractured or broken bones; eye damage; cuts, wounds, scrapes, abrasions, and/or contusions; dehydration, oxygen shortage (anoxia), exposure and/or altitude sickness; head, neck and/or spinal injuries; shock, paralysis, drowning, and/or death; and acknowledge that during the activity I/we may experience fatigue, chill and/or dizziness which may diminish my/our reaction time and increase the risk of an accident.

COVENANT OF GOOD FAITH: I recognize that SKYDIVE MESQUITE, as provider of services, will operate under a covenant of good faith and fair dealing, but that SKYDIVE MESQUITE may find it necessary to terminate an activity due to forces of nature, medical necessities or problems in the group, and/or refuse or terminate, the participation of any person SKYDIVE MESQUITE judges to be incapable of meeting the rigors or requirements of participating in the activity. I accept SKYDIVE MESQUITE’S right to take such actions for the safety of myself and/or other participants. I acknowledge that no guarantees have been made with respect to sport parachuting and/or skydiving objectives.

AUTHORIZATION: I hereby authorize any medical treatment deemed necessary in the event of any injury or illness while participating in the activity. I either have appropriate insurance or, in its absence, agree to pay all costs of rescue and/or medical services as may be incurred on my/our behalf.

LIABILITY RELEASE: In consideration of services or property provided, I, for myself and any minor children for which I am parent, legal guardian or otherwise responsible, any heirs, personal representative or assigns, do hereby voluntarily release, waive and discharge UNITED PARACHUTE TECHNOLOGIES. LLC, SKYDIVE MESQUITE, LLC, VERTICAL INVESTMENT STRATEGIES, LLC, SPOKANE TURBINE SKYDIVING, LLC, WEST PLAINS SKYDIVING, LLC, USPA and manufacturers, distributors and dealers of skydiving equipment, its principals, directors, officers, agents, employees and volunteers, from all liability and waive any claim for damage arising from any cause whatsoever (except that which is the result of gross negligence).

ARBITRATION: Any controversy or claim arising out of or relating to the Agreement, or the breach thereof, including without limitation any claim related to illness, injury or death, shall be subject to the following conditions: 1) the dispute shall be settled by binding arbitration in Las Vegas, Nevada, or in any jurisdiction that SKYDIVE MESQUITE elects in accordance with the Commercial Arbitration Rules of the American Arbitration Association then existing; and 2) the dispute will be governed by Nevada law. This agreement to arbitrate does not waive or modify the liability releases contained in the foregoing paragraph.

KNOWING AND VOLUNTARY EXECUTION: I have read the foregoing acknowledgment of risk, assumption of risk and responsibility, and release of liability. I understand that by signing this document I may be waiving valuable legal rights.

Today's Date: March 29, 2020

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information
jumper type*
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Information
jumper type*
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Information
jumper type*
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information
jumper type*
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information
jumper type*
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information
jumper type*
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information
jumper type*
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information
jumper type*
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information
jumper type*
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information
jumper type*
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*
Check to receive information, news, and discounts by e-mail.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
For Experienced Jumpers

Number of Jumps

U.S.P.A Member Number

Reserve Repack Date

U.S.P.A license number

Last Jump Date

Age

Weight

U.S.P.A member expiry date
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*

Last Name*

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