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Skydive Awesome!  LLC
REGISTRATION AND MEDICAL STATEMENT

There will be no refunds due to weather
Skydive Awesome!  LLC
RELEASE, INDEMNITY AND ASSUMPTION OF RISK AGREEMENT

IN CONSIDERATION of Skydive Awesome! LLC, agreement to allow me to use its facilities and equipment and to voluntarily participate in parachute activities, generally defined as ground instruction, flying in aircraft and related activities, skydiving, freefall and/or tandem jumping, hereinafter collectively referred to as "Skydiving Activities", I accept and agree as follows:

I Agree

1. WARNING: ASSUMPTION OF RISK!

SKYDIVING ACTIVITES ARE DANGEROUS AND THERE ARE RISKS INVOLVED IN MY PARTICIPATION. I CAN BE SERIOUSLY AND PERMANENTLY INJURED OR EVEN KILLED AS A RESULT OF MY PARTICIPATION IN SKYDIVING ACTIVITIES. I AM VOLUNTARILY PARTICIPATING IN SKYDIVING ACTIVITIES, AND I AGREE TO FOLLOW INSTRUCTION AND STRICTLY ADHERE TO ALL SAFETY GUIDELINES RELATED TO SKYDIVING ACTIVITIES. PARTICIPATION IN SKYDIVING ACTIVITIES IS A PURELY VOLUNTARY. BY SIGNING THIS RELEASE, INDEMNITY AND ASSUMPTION OF RISK AGREEMENT I ACCEPT AND ASSUME THE RISK OF PARTICIPATING IN SKYDIVING ACTIVITIES AND ACKNOWLEDGE AND UNDERSTAND THAT SKYDIVING ACTIVITIES ARE SO DANGEROUS THAT SKYDIVE AWESOME (defined in Paragraph 2 below) CAN NOT PURCHASE LIABILITY INSURANCE, AND AS A RESULT, IF I AM INJURED WHILE PARTICIPATING IN SKYDIVING ACTIVITIES, SKYDIVE AWESOME DOES NOT HAVE LIABILITY INSURANCE TO COVER MY INJURY.

I Agree 

2.  RELEASE AND INDEMNITY

I AGREE TO RELEASE AND INDEMNIFY OFF THE STEP, INC. ITS OFFICERS, DIRECTORS, SHAREHOLDERS, OWNERS, AGENTS, INDEPENDENT CONTRACTORS THAT PROVIDE SERVICES TO OFF THE STEP INC., LANDOWNERS, LESSORS AND EMPLOYEES (together defined as “Skydive Awesome”) USPA AND MANUFACTORERS, DISTRIBUTORS AND DEALERS OF SKYDIVE EQUIPMENT IN THE GROUP MEMBER HOLD-HARMLESS RELEASE, CONSISTENT STATE LAWS FROM ANY AND ALL CLAIMS (TOGETHER WITH REASONABLE ATTORNEY FEES AND COSTS), FOR PROPERTY DAMAGE, INJURY, DEATH INCLUDING BUT NOT LIMTED TO WRONGFUL DEATH, WHICH I MAY SUFFER OR FOR WHICH I MAY BE LIABLE TO OTHERS, IN ANYWAY CONNECTED WITH SKYDIVING ACTIVITIES (“Claims”). EXCEPT AS EXPRESSLY RELEASED BY THIS PARAGRAPH 2, THIS RELEASE AND INDEMNITY SHALL APPLY TO ANY AND ALL CLAIMS EVEN IF CAUSED BY NEGLIGENCE(“Released Claims”). THE ONLY CLAIMS NOT RELEASED ARE THOSE BASED UPON INTENTIONAL MISCOUNDUCT, GROSS NEGLIGENCE OR RECKLESSNESS. I UNDERSTAND THAT BY SIGNING THIS AGREEMENT, I AM GIVING UP LEGAL RIGHTS WHICH I OR MY HEIRS MIGHT OTHERWISE HAVE, AND I DO SO WILLINGLY AND WITH FULL KNOWLEDGE OF THAT CONSEQUENCE SO I CAN PARTICIPATE IN SKYDIVING ACTIVITIES.

I Agree 

3. CONTEMLATED RISKS. This Release, Indemnity and Assumption Agreement (“Agreement”) is made in contemplation of the risks associated with “Skydiving Activities”, and I accept and assume the risks associated with Skydiving Activities which include, but are not be limited to, all risks and occurrences contemplated or not contemplated, foreseen and unforeseen, likely or unlikely to occur, including but not limited to instruction, parachute jumping, tandem or experimental test parachute jumping, ground instruction, flying, flying in aircraft and related activities, the transportation to and from an aircraft, the exit from the aircraft, skydiving, freefall, canopy opening, time under the canopy, the landing, including but not limited to crash landings, either under canopy or not, inside or outside the aircraft, equipment malfunctions of any kind, any rescue operations or attempts, whether on or off the designated landing area or any facilities used by Skydive Awesome, and any activity connected with my Skydiving Activities.

I Agree 

4. COVENANT NOT TO SUE. I agree not to institute any lawsuit or action at law of otherwise, and hereby instruct and direct my heirs, personal representatives, executors, and administrators not to institute any lawsuit or action at law or otherwise, against Skydive Awesome related to the Released Claims (defined in Paragraph 2 above). I understand and agree that if I or my heirs initiate any legal action against Skydive Awesome related to the Released Claims, then I or my estate agree to pay and Skydive Awesome will be entitled to recover from me or my estate, in addition to any other relief awarded, Skydive Awesome’s reasonable attorney's fees and other fees, costs, and expenses of every kind, including but not limited to the costs and disbursements specified in ORCP 68 A(2), incurred in connection with its defense of the Released Claims, including without limitation the arbitration, the litigation, any appeal or petition for review, the collection of any award, or the enforcement of any order, as determined by the court.

I Agree 

5. STATEMENT OF MEDICAL FITNESS. I, represent and warrant that I have no physical or mental infirmities or disabilities that would prevent me from safely participating in Skydiving Activities. I am not under treatment for any other physical or mental infirmity or chronic ailment or injury of any nature; and 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 or related diseases, high or low blood pressures, shoulder dislocation, or any other disability which might in any way affect my ability to participate in Skydiving Activities. I further assert that I am not under the influence of any drugs, legal or illegal, or under the influence of alcohol or other substance that would affect my health or my ability to read and understand this Release, Indemnity and Assumption Agreement. I recognize that I am solely and only responsible for any medical conditions I may have and the effect any of those medical conditions may have on my Skydiving Activities. If I have any questions or concerns, I agree that it is my responsibility to check with my physician before I participate in Skydiving Activities.

I Agree 

6. REPRESENTATION OF AGE, INFORMATION AND UNDERSTANDING. I represent that I am at least eighteen years of age, I have provided accurate and up to date information to Skydive Awesome, and I understand that this Agreement is a legally binding document enforceable by it terms. I agree and am aware that this Agreement contains RELEASE AND INDEMNITY and ASSUMPTION OF RISK provisions and I agree to and fully understand that these provisions limit my rights and the rights of my estate to recover damages from Skydive Awesome. I am aware that this Agreement supersedes any oral representations made by Skydive Awesome prior to me signing of this Agreement and I acknowledge that I have not relied on any oral representations by Skydive Awesome made prior to signing of this Agreement.

I Agree 

7. AGREEMENT TO OBSERVE RULES AND GUIDELINES.  I understand that the right to participate and engage in Skydiving Activities under this Agreement is conditional on strict observation of rules and safety guidelines of which I have been informed, and which are posted in plain view at Skydive Awesome’s facility.  By my signature below, I certify I am familiar with those rules and guidelines and promise to strictly abide by them while participating in Skydiving Activities.

I Agree 

8. MEDIA RELEASE. I hereby authorize Skydive Awesome to take photographs and video of me participating in Skydiving Activities, and to use such photographs and videos in such a manner, as Skydive Awesome may deem appropriate for the promotion of its business. I specifically waive any interest, proprietary rights or otherwise, I may have in such photographs.

I Agree 

9. VENUE AND GOVERNING LAW. I agree that any legal action or proceeding arising out of this Agreement will be litigated in courts located in Jefferson County Oregon. I further agree that this Agreement is governed by Oregon law without regard to conflict of law principles.


I Agree 

10. BINDING EFFECT. I understand that this Agreement is binding on me, my estate, my heirs, and my personal representatives.

I Agree 

11. Viewing of Videotape: I have viewed, and I warrant that I fully understand the accompanying “Tandem Vector Waiver” video tape.

I Agree 

12. I UNDERSTAND THIS AGREEMENT: BY MY SIGNATURE BELOW I ACKNOWLEDGE AND AGREE THAT I HAVE CAREFULLY READ AND UNDERSTAND THIS AGREEMENT AND ALL OF ITS TERMS. THIS INCLUDES BUT IS NOT LIMITED TO, THE SAFETY RULES WHICH I AGREE TO FOLLOW AND OBSERVE. BY MY SIGNATURE BELOW I ACKNOWLEDGE AND AGREE THAT THIS AGREEMENT IS AN AGREEMENT RELEASE, INDEMNITY AND ASSUMPTION OF RISK WHICH WILL PREVENT ME OR MY ESTATE FROM RECOVERING DAMAGES FROM SKYDIVE AWESOME IN THE EVENT OF MY DEATH, WRONGFUL DEATH, OR INJURY TO PERSON OR PROPERTY. I NEVERTHELESS, ENTER INTO THIS AGREEMENT FREELY AND VOLUNTARILY AND AGREE IT IS BINDING ON ME AND MY HEIRS AND LEGAL REPRESENTATIVES. BY MY SIGNATURE BELOW I AGREE THIS RELEASE, INDEMNITY AND ASSUMPTION OF RISK AGREEMENT WILL CONTINUE AND REMAIN IN FULL FORCE AND EFFECT, AND I WILL BE BOUND BY ITS TERMS AT ALL TIMES INCLUDING BUT NOT LIMITED TO, AT ALL TIMES WHEN I PARTICIPATE IN SKYDIVING ACTIVITIES WITH SKYDIVE AWESOME.

I Agree 

Today's Date: September 28, 2021

First Participant's Name

First Name*

Last Name*

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

HEIGHT

WEIGHT

MEDICAL STATEMENT FOR SKYDIVING AND OTHER ACTIVITIES:

I hereby certify that I am not aware of and am not now under the treatment for any infirmities of illness which would affect my ability to engage in skydiving and that I am not under treatment for any of the following:

1. Cardiac or pulmonary condition or disease*
No
Yes
2. High or low blood pressure*
No
Yes
3. Fainting spells or convulsions*
No
Yes
4. Hearing loss or impairment*
No
Yes
5. Nervous disorders*
No
Yes
6. Diabetes*
No
Yes
7. Kidney or related disease*
No
Yes
8. Shortness of breath*
No
Yes
9. Scuba diving in last 24 hours*
No
Yes

GENERAL HEALTH
jumper type*
First Participant's Signature*
Second Participant's Name

First Name*

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

HEIGHT

WEIGHT

MEDICAL STATEMENT FOR SKYDIVING AND OTHER ACTIVITIES:

I hereby certify that I am not aware of and am not now under the treatment for any infirmities of illness which would affect my ability to engage in skydiving and that I am not under treatment for any of the following:

1. Cardiac or pulmonary condition or disease*
No
Yes
2. High or low blood pressure*
No
Yes
3. Fainting spells or convulsions*
No
Yes
4. Hearing loss or impairment*
No
Yes
5. Nervous disorders*
No
Yes
6. Diabetes*
No
Yes
7. Kidney or related disease*
No
Yes
8. Shortness of breath*
No
Yes
9. Scuba diving in last 24 hours*
No
Yes

GENERAL HEALTH
jumper type*
Third Participant's Name

First Name*

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

HEIGHT

WEIGHT

MEDICAL STATEMENT FOR SKYDIVING AND OTHER ACTIVITIES:

I hereby certify that I am not aware of and am not now under the treatment for any infirmities of illness which would affect my ability to engage in skydiving and that I am not under treatment for any of the following:

1. Cardiac or pulmonary condition or disease*
No
Yes
2. High or low blood pressure*
No
Yes
3. Fainting spells or convulsions*
No
Yes
4. Hearing loss or impairment*
No
Yes
5. Nervous disorders*
No
Yes
6. Diabetes*
No
Yes
7. Kidney or related disease*
No
Yes
8. Shortness of breath*
No
Yes
9. Scuba diving in last 24 hours*
No
Yes

GENERAL HEALTH
jumper type*
Fourth Participant's Name

First Name*

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

HEIGHT

WEIGHT

MEDICAL STATEMENT FOR SKYDIVING AND OTHER ACTIVITIES:

I hereby certify that I am not aware of and am not now under the treatment for any infirmities of illness which would affect my ability to engage in skydiving and that I am not under treatment for any of the following:

1. Cardiac or pulmonary condition or disease*
No
Yes
2. High or low blood pressure*
No
Yes
3. Fainting spells or convulsions*
No
Yes
4. Hearing loss or impairment*
No
Yes
5. Nervous disorders*
No
Yes
6. Diabetes*
No
Yes
7. Kidney or related disease*
No
Yes
8. Shortness of breath*
No
Yes
9. Scuba diving in last 24 hours*
No
Yes

GENERAL HEALTH
jumper type*
Fifth Participant's Name

First Name*

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

HEIGHT

WEIGHT

MEDICAL STATEMENT FOR SKYDIVING AND OTHER ACTIVITIES:

I hereby certify that I am not aware of and am not now under the treatment for any infirmities of illness which would affect my ability to engage in skydiving and that I am not under treatment for any of the following:

1. Cardiac or pulmonary condition or disease*
No
Yes
2. High or low blood pressure*
No
Yes
3. Fainting spells or convulsions*
No
Yes
4. Hearing loss or impairment*
No
Yes
5. Nervous disorders*
No
Yes
6. Diabetes*
No
Yes
7. Kidney or related disease*
No
Yes
8. Shortness of breath*
No
Yes
9. Scuba diving in last 24 hours*
No
Yes

GENERAL HEALTH
jumper type*
Sixth Participant's Name

First Name*

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

HEIGHT

WEIGHT

MEDICAL STATEMENT FOR SKYDIVING AND OTHER ACTIVITIES:

I hereby certify that I am not aware of and am not now under the treatment for any infirmities of illness which would affect my ability to engage in skydiving and that I am not under treatment for any of the following:

1. Cardiac or pulmonary condition or disease*
No
Yes
2. High or low blood pressure*
No
Yes
3. Fainting spells or convulsions*
No
Yes
4. Hearing loss or impairment*
No
Yes
5. Nervous disorders*
No
Yes
6. Diabetes*
No
Yes
7. Kidney or related disease*
No
Yes
8. Shortness of breath*
No
Yes
9. Scuba diving in last 24 hours*
No
Yes

GENERAL HEALTH
jumper type*
Seventh Participant's Name

First Name*

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

HEIGHT

WEIGHT

MEDICAL STATEMENT FOR SKYDIVING AND OTHER ACTIVITIES:

I hereby certify that I am not aware of and am not now under the treatment for any infirmities of illness which would affect my ability to engage in skydiving and that I am not under treatment for any of the following:

1. Cardiac or pulmonary condition or disease*
No
Yes
2. High or low blood pressure*
No
Yes
3. Fainting spells or convulsions*
No
Yes
4. Hearing loss or impairment*
No
Yes
5. Nervous disorders*
No
Yes
6. Diabetes*
No
Yes
7. Kidney or related disease*
No
Yes
8. Shortness of breath*
No
Yes
9. Scuba diving in last 24 hours*
No
Yes

GENERAL HEALTH
jumper type*
Eighth Participant's Name

First Name*

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

HEIGHT

WEIGHT

MEDICAL STATEMENT FOR SKYDIVING AND OTHER ACTIVITIES:

I hereby certify that I am not aware of and am not now under the treatment for any infirmities of illness which would affect my ability to engage in skydiving and that I am not under treatment for any of the following:

1. Cardiac or pulmonary condition or disease*
No
Yes
2. High or low blood pressure*
No
Yes
3. Fainting spells or convulsions*
No
Yes
4. Hearing loss or impairment*
No
Yes
5. Nervous disorders*
No
Yes
6. Diabetes*
No
Yes
7. Kidney or related disease*
No
Yes
8. Shortness of breath*
No
Yes
9. Scuba diving in last 24 hours*
No
Yes

GENERAL HEALTH
jumper type*
Ninth Participant's Name

First Name*

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

HEIGHT

WEIGHT

MEDICAL STATEMENT FOR SKYDIVING AND OTHER ACTIVITIES:

I hereby certify that I am not aware of and am not now under the treatment for any infirmities of illness which would affect my ability to engage in skydiving and that I am not under treatment for any of the following:

1. Cardiac or pulmonary condition or disease*
No
Yes
2. High or low blood pressure*
No
Yes
3. Fainting spells or convulsions*
No
Yes
4. Hearing loss or impairment*
No
Yes
5. Nervous disorders*
No
Yes
6. Diabetes*
No
Yes
7. Kidney or related disease*
No
Yes
8. Shortness of breath*
No
Yes
9. Scuba diving in last 24 hours*
No
Yes

GENERAL HEALTH
jumper type*
Tenth Participant's Name

First Name*

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

HEIGHT

WEIGHT

MEDICAL STATEMENT FOR SKYDIVING AND OTHER ACTIVITIES:

I hereby certify that I am not aware of and am not now under the treatment for any infirmities of illness which would affect my ability to engage in skydiving and that I am not under treatment for any of the following:

1. Cardiac or pulmonary condition or disease*
No
Yes
2. High or low blood pressure*
No
Yes
3. Fainting spells or convulsions*
No
Yes
4. Hearing loss or impairment*
No
Yes
5. Nervous disorders*
No
Yes
6. Diabetes*
No
Yes
7. Kidney or related disease*
No
Yes
8. Shortness of breath*
No
Yes
9. Scuba diving in last 24 hours*
No
Yes

GENERAL HEALTH
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*
Parent or Guardian's Driver's License / ID Card

Driver's License / ID Card Number*

Issuing State*
Licensed Skydivers Only

U.S.P.A Member Number

U.S.P.A Expiry

LICENSE AND CURRENT RATING

Reserve Repack Date

Date of Last Jump and Location

Total # Jumps

Parachute Make and Size
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

HEIGHT

WEIGHT

MEDICAL STATEMENT FOR SKYDIVING AND OTHER ACTIVITIES:

I hereby certify that I am not aware of and am not now under the treatment for any infirmities of illness which would affect my ability to engage in skydiving and that I am not under treatment for any of the following:

1. Cardiac or pulmonary condition or disease*
No
Yes
2. High or low blood pressure*
No
Yes
3. Fainting spells or convulsions*
No
Yes
4. Hearing loss or impairment*
No
Yes
5. Nervous disorders*
No
Yes
6. Diabetes*
No
Yes
7. Kidney or related disease*
No
Yes
8. Shortness of breath*
No
Yes
9. Scuba diving in last 24 hours*
No
Yes

GENERAL HEALTH
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.


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