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SKYDIVE GRAND HAVEN AGREEMENT, RELEASE OF LIABILITY AND ASSUMPTION OF RISK

THIS WAIVER MUST BE SIGNED ENTIRELY AND SOLELY BY THE PARTICIPANT WHO IS INTENDING TO MAKE A SKYDIVE AT SKYDIVE GRAND HAVEN AND MUST BE SIGNED BY EACH PERSON MAKING A SKYDIVE. IT CAN NOT BE SIGNED ON SOMEONE ELSE'S BEHALF.

In consideration of being permitted to utilize the facilities and equipment of Skydive Grand Haven, (and its
associated entities), to engage in parachuting activities, ground instruction, flying and related activities,
hereinafter collectively referred to as “Parachuting Activities.” I hereby agree as follows:


Parties Included. I understand that this Agreement, Release of Liability and Assumption of Risk includes the City
of Grand Haven, Ottawa County, their officers, employees, volunteers and agents, E2 Technologies, Inc., Earle Bares Airport Manager, Tony Gwinn, Skydive Wayland LLC, and Skydive Grand
Haven, LLC, its agents, associated entities, managers, members, partners, employees, pilots, instructors, jump
masters, parachute packers, the owners of the aircraft and land utilized for “Parachuting Activities,” the United
States Parachute Association and its members, equipment manufacturers, the World Skydiving Association
and its members, the State of Michigan, anyone working with
or for Skydive Grand Haven, and anyone involved in my “Parachuting Activities,” hereinafter referred to in this
Agreement, Release of Liability and Assumption of Risk as “Skydive.” All of the above parties are hereby
collectively referred to as the “Released Parties.”



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, free fall, time under
canopy, the landing, any rescue operations or attempts by “Skydive” whether on, above, or off the area
known as Grand Haven Memorial Airport, Grand Haven, Michigan, or any facilities used by “Skydive.”



Release From Liability. I hereby release and discharge the above “Released Parties” from any and all liability,
claims, demands, or causes of action that I may hereafter have for injuries or damages arising out of my
participation in “Parachuting Activities” even if caused by negligence or other fault of the above “Released
Parties.”



Covenant Not To Sue. I further agree that I will not sue or make claim against the above “Released Parties” for
damages or other losses sustained as a result of my participation in “Parachuting Activities” even if caused by
negligence or other fault of the above “Released Parties.”



Indemnification And Hold Harmless. I also agree to indemnify and hold the above “Released Parties” harmless
from all claims, judgments and costs, including but not limited to attorney fees, and to reimburse them for any
expenses whatsoever incurred in connection with any action brought as a result of my participation in
“Parachuting Activities.” I further agree that part of my obligation to indemnify and hold the above “Released
Parties” harmless from all claims, judgments, and costs, I agree to post a bond in the amount of $5,000.00 in
favor of the above “Released Parties,” in the event any action is brought as a result of my participation in
“Parachuting Activities.”



Assumption Of Risk. I understand and acknowledge that “Parachuting Activities” are inherently dangerous
and I expressly and voluntarily assume all risk of death or personal injury sustained while participating in
“Parachuting Activities,” whether or not caused by the negligence or other fault of the above “Released
Parties,” including but not limited to equipment malfunction from whatever cause, inadequate training, any
deficiencies in the landing area, rescue attempts, bad landing, or any other injury I may sustain even if caused
by negligence or any fault of the above “Released Parties.”


Parties Bound By This Agreement. It is my understanding that this agreement be binding not only on myself, but
on anyone or any entity, including my estate and my heirs, that or who may be able to or does sue because
of my injury or death. It is further my understanding and agreement that this agreement is intended to and
does in fact release the above “Released Parties” from any and all claims or obligations whatsoever arising in
any way from my participation in “Parachuting Activities,” even if caused by the negligence or other fault of
the above “Released Parties.”



Limitation Of Warranty. “Skydive” hereby warrants that the equipment provided by “Skydive” has been
previously used for “Parachuting Activities.” This warranty is the only warranty made and is made in lieu of any
other warranties, express or implied, including but not limited to warranty of merchantability or fitness for a
particular purpose.



I have read the above paragraph and acknowledge that I understand it and accept the limitation of warranty.




Duration Of Release. It is my understanding and intention that this agreement be effective not only for my first
jump, but for any subsequent jumps or activities which are in any way associated with the above “Released
Parties,” no matter when they might occur.



Enforceability. I agree that if any portions of this agreement are found to be unenforceable or against public
policy, that only that portion shall fail, but I specifically waive any unenforceability or any policy or any policy
argument that I may make or that may be made on behalf of my estate or by anyone who would sue
because of my injury or death.



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.


I hereby agree to waive all duty of care, whether by omission or commission, or any other duty which may be
owed to me by the above “Released Parties.”



It is my agreement with the above “Released Parties” and my intention that this document be broadly
construed in favor of the above “Released Parties” and against me and that any and all ambiguities be
resolved in favor of the above “Released Parties.”



Choice Of Laws. I agree that this agreement shall be interpreted under the laws of the state of Michigan, no
matter where I reside or where I execute this agreement and participate in activities with “Skydive.”



Right To Use Name And/Or Likeness in Advertising. I further acknowledge and agree that during the course of
my participation in skydiving activities, “Skydive” may videotape or photograph me. I expressly agree to the
use of my name, photograph, or any video footage involving me for advertising purposes, and release
“Skydive” for any and all liability thereof.



Understanding Of Agreement. I hereby certify that I have read and understand the contents of this document
and I wish to be bound by it's terms.


I hereby certify and warrant that the statements contained below  in the "Participant Info" portion of waiver are true and correct to the best of my knowledge and belief. I further certify and understand that acceptance of this application by Skydive Grand Haven will be made on the basis of the statements contained above, and such accepted application will become part of the agreement between myself and SkydiveGrand Haven to provide the service.

Participation in the sport of skydiving could cause serious injury or even death. It is an adult sport and should be considered such.

 

First Participant's Name

First Name*

Middle Name

Last Name*

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

WEIGHT (lbs) *You will be weighed at check-in. If over 220lbs additional charges may apply. We CANNOT take jumpers weighing over 260 - please see our FAQs for additional weight information* *

HEIGHT (in ft/in) *

EMERGENCY CONTACT NAME (First and Last) *

EMERGENCY CONTACT PHONE NUMBER *
I have been treated for the following: (If you HAVE been treated for any of the following - check box) *Please note - these conditions may or may not prevent you from making a skydive*
Cardiac or pulmonary condition or disease
Fainting spells, convulsions, or epilepsy
Hearing Loss
High or low blood pressure
Nervous or mental disorder
Diabetes
Kidney or related diseases
Back injury
Alcoholism
Drug addiction or dependency
Any orthopedic problems
Are you aware of or under treatment for any physical infirmity or chronic ailment or injury of any nature which could affect your ability to train and/or jump safely?*
No
Yes

If you are aware of or are under treatment for any physical infirmity or chronic ailment or injury of any nature which could affect your ability to train and/or jump safely, please describe.
Are you under any kind of medication at the current time - or will you be under any medication when you make a skydive at Skydive Grand Haven?*

If under medication - please describe (if no - leave blank)
Do you have normal vision or wear corrective lenses?*
How did you hear about Skydive Grand Haven?
From a Friend/Family
Facebook Ad
Instagram
Flyer/poster
Radio
Google Search
Saw skydivers in Grand Haven
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

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

WEIGHT (lbs) *You will be weighed at check-in. If over 220lbs additional charges may apply. We CANNOT take jumpers weighing over 260 - please see our FAQs for additional weight information* *

HEIGHT (in ft/in) *

EMERGENCY CONTACT NAME (First and Last) *

EMERGENCY CONTACT PHONE NUMBER *
I have been treated for the following: (If you HAVE been treated for any of the following - check box) *Please note - these conditions may or may not prevent you from making a skydive*
Cardiac or pulmonary condition or disease
Fainting spells, convulsions, or epilepsy
Hearing Loss
High or low blood pressure
Nervous or mental disorder
Diabetes
Kidney or related diseases
Back injury
Alcoholism
Drug addiction or dependency
Any orthopedic problems
Are you aware of or under treatment for any physical infirmity or chronic ailment or injury of any nature which could affect your ability to train and/or jump safely?*
No
Yes

If you are aware of or are under treatment for any physical infirmity or chronic ailment or injury of any nature which could affect your ability to train and/or jump safely, please describe.
Are you under any kind of medication at the current time - or will you be under any medication when you make a skydive at Skydive Grand Haven?*

If under medication - please describe (if no - leave blank)
Do you have normal vision or wear corrective lenses?*
How did you hear about Skydive Grand Haven?
From a Friend/Family
Facebook Ad
Instagram
Flyer/poster
Radio
Google Search
Saw skydivers in Grand Haven
Third Participant's Name

First Name*

Middle Name

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

WEIGHT (lbs) *You will be weighed at check-in. If over 220lbs additional charges may apply. We CANNOT take jumpers weighing over 260 - please see our FAQs for additional weight information* *

HEIGHT (in ft/in) *

EMERGENCY CONTACT NAME (First and Last) *

EMERGENCY CONTACT PHONE NUMBER *
I have been treated for the following: (If you HAVE been treated for any of the following - check box) *Please note - these conditions may or may not prevent you from making a skydive*
Cardiac or pulmonary condition or disease
Fainting spells, convulsions, or epilepsy
Hearing Loss
High or low blood pressure
Nervous or mental disorder
Diabetes
Kidney or related diseases
Back injury
Alcoholism
Drug addiction or dependency
Any orthopedic problems
Are you aware of or under treatment for any physical infirmity or chronic ailment or injury of any nature which could affect your ability to train and/or jump safely?*
No
Yes

If you are aware of or are under treatment for any physical infirmity or chronic ailment or injury of any nature which could affect your ability to train and/or jump safely, please describe.
Are you under any kind of medication at the current time - or will you be under any medication when you make a skydive at Skydive Grand Haven?*

If under medication - please describe (if no - leave blank)
Do you have normal vision or wear corrective lenses?*
How did you hear about Skydive Grand Haven?
From a Friend/Family
Facebook Ad
Instagram
Flyer/poster
Radio
Google Search
Saw skydivers in Grand Haven
Fourth Participant's Name

First Name*

Middle Name

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

WEIGHT (lbs) *You will be weighed at check-in. If over 220lbs additional charges may apply. We CANNOT take jumpers weighing over 260 - please see our FAQs for additional weight information* *

HEIGHT (in ft/in) *

EMERGENCY CONTACT NAME (First and Last) *

EMERGENCY CONTACT PHONE NUMBER *
I have been treated for the following: (If you HAVE been treated for any of the following - check box) *Please note - these conditions may or may not prevent you from making a skydive*
Cardiac or pulmonary condition or disease
Fainting spells, convulsions, or epilepsy
Hearing Loss
High or low blood pressure
Nervous or mental disorder
Diabetes
Kidney or related diseases
Back injury
Alcoholism
Drug addiction or dependency
Any orthopedic problems
Are you aware of or under treatment for any physical infirmity or chronic ailment or injury of any nature which could affect your ability to train and/or jump safely?*
No
Yes

If you are aware of or are under treatment for any physical infirmity or chronic ailment or injury of any nature which could affect your ability to train and/or jump safely, please describe.
Are you under any kind of medication at the current time - or will you be under any medication when you make a skydive at Skydive Grand Haven?*

If under medication - please describe (if no - leave blank)
Do you have normal vision or wear corrective lenses?*
How did you hear about Skydive Grand Haven?
From a Friend/Family
Facebook Ad
Instagram
Flyer/poster
Radio
Google Search
Saw skydivers in Grand Haven
Fifth Participant's Name

First Name*

Middle Name

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

WEIGHT (lbs) *You will be weighed at check-in. If over 220lbs additional charges may apply. We CANNOT take jumpers weighing over 260 - please see our FAQs for additional weight information* *

HEIGHT (in ft/in) *

EMERGENCY CONTACT NAME (First and Last) *

EMERGENCY CONTACT PHONE NUMBER *
I have been treated for the following: (If you HAVE been treated for any of the following - check box) *Please note - these conditions may or may not prevent you from making a skydive*
Cardiac or pulmonary condition or disease
Fainting spells, convulsions, or epilepsy
Hearing Loss
High or low blood pressure
Nervous or mental disorder
Diabetes
Kidney or related diseases
Back injury
Alcoholism
Drug addiction or dependency
Any orthopedic problems
Are you aware of or under treatment for any physical infirmity or chronic ailment or injury of any nature which could affect your ability to train and/or jump safely?*
No
Yes

If you are aware of or are under treatment for any physical infirmity or chronic ailment or injury of any nature which could affect your ability to train and/or jump safely, please describe.
Are you under any kind of medication at the current time - or will you be under any medication when you make a skydive at Skydive Grand Haven?*

If under medication - please describe (if no - leave blank)
Do you have normal vision or wear corrective lenses?*
How did you hear about Skydive Grand Haven?
From a Friend/Family
Facebook Ad
Instagram
Flyer/poster
Radio
Google Search
Saw skydivers in Grand Haven
Sixth Participant's Name

First Name*

Middle Name

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

WEIGHT (lbs) *You will be weighed at check-in. If over 220lbs additional charges may apply. We CANNOT take jumpers weighing over 260 - please see our FAQs for additional weight information* *

HEIGHT (in ft/in) *

EMERGENCY CONTACT NAME (First and Last) *

EMERGENCY CONTACT PHONE NUMBER *
I have been treated for the following: (If you HAVE been treated for any of the following - check box) *Please note - these conditions may or may not prevent you from making a skydive*
Cardiac or pulmonary condition or disease
Fainting spells, convulsions, or epilepsy
Hearing Loss
High or low blood pressure
Nervous or mental disorder
Diabetes
Kidney or related diseases
Back injury
Alcoholism
Drug addiction or dependency
Any orthopedic problems
Are you aware of or under treatment for any physical infirmity or chronic ailment or injury of any nature which could affect your ability to train and/or jump safely?*
No
Yes

If you are aware of or are under treatment for any physical infirmity or chronic ailment or injury of any nature which could affect your ability to train and/or jump safely, please describe.
Are you under any kind of medication at the current time - or will you be under any medication when you make a skydive at Skydive Grand Haven?*

If under medication - please describe (if no - leave blank)
Do you have normal vision or wear corrective lenses?*
How did you hear about Skydive Grand Haven?
From a Friend/Family
Facebook Ad
Instagram
Flyer/poster
Radio
Google Search
Saw skydivers in Grand Haven
Seventh Participant's Name

First Name*

Middle Name

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

WEIGHT (lbs) *You will be weighed at check-in. If over 220lbs additional charges may apply. We CANNOT take jumpers weighing over 260 - please see our FAQs for additional weight information* *

HEIGHT (in ft/in) *

EMERGENCY CONTACT NAME (First and Last) *

EMERGENCY CONTACT PHONE NUMBER *
I have been treated for the following: (If you HAVE been treated for any of the following - check box) *Please note - these conditions may or may not prevent you from making a skydive*
Cardiac or pulmonary condition or disease
Fainting spells, convulsions, or epilepsy
Hearing Loss
High or low blood pressure
Nervous or mental disorder
Diabetes
Kidney or related diseases
Back injury
Alcoholism
Drug addiction or dependency
Any orthopedic problems
Are you aware of or under treatment for any physical infirmity or chronic ailment or injury of any nature which could affect your ability to train and/or jump safely?*
No
Yes

If you are aware of or are under treatment for any physical infirmity or chronic ailment or injury of any nature which could affect your ability to train and/or jump safely, please describe.
Are you under any kind of medication at the current time - or will you be under any medication when you make a skydive at Skydive Grand Haven?*

If under medication - please describe (if no - leave blank)
Do you have normal vision or wear corrective lenses?*
How did you hear about Skydive Grand Haven?
From a Friend/Family
Facebook Ad
Instagram
Flyer/poster
Radio
Google Search
Saw skydivers in Grand Haven
Eighth Participant's Name

First Name*

Middle Name

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

WEIGHT (lbs) *You will be weighed at check-in. If over 220lbs additional charges may apply. We CANNOT take jumpers weighing over 260 - please see our FAQs for additional weight information* *

HEIGHT (in ft/in) *

EMERGENCY CONTACT NAME (First and Last) *

EMERGENCY CONTACT PHONE NUMBER *
I have been treated for the following: (If you HAVE been treated for any of the following - check box) *Please note - these conditions may or may not prevent you from making a skydive*
Cardiac or pulmonary condition or disease
Fainting spells, convulsions, or epilepsy
Hearing Loss
High or low blood pressure
Nervous or mental disorder
Diabetes
Kidney or related diseases
Back injury
Alcoholism
Drug addiction or dependency
Any orthopedic problems
Are you aware of or under treatment for any physical infirmity or chronic ailment or injury of any nature which could affect your ability to train and/or jump safely?*
No
Yes

If you are aware of or are under treatment for any physical infirmity or chronic ailment or injury of any nature which could affect your ability to train and/or jump safely, please describe.
Are you under any kind of medication at the current time - or will you be under any medication when you make a skydive at Skydive Grand Haven?*

If under medication - please describe (if no - leave blank)
Do you have normal vision or wear corrective lenses?*
How did you hear about Skydive Grand Haven?
From a Friend/Family
Facebook Ad
Instagram
Flyer/poster
Radio
Google Search
Saw skydivers in Grand Haven
Ninth Participant's Name

First Name*

Middle Name

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

WEIGHT (lbs) *You will be weighed at check-in. If over 220lbs additional charges may apply. We CANNOT take jumpers weighing over 260 - please see our FAQs for additional weight information* *

HEIGHT (in ft/in) *

EMERGENCY CONTACT NAME (First and Last) *

EMERGENCY CONTACT PHONE NUMBER *
I have been treated for the following: (If you HAVE been treated for any of the following - check box) *Please note - these conditions may or may not prevent you from making a skydive*
Cardiac or pulmonary condition or disease
Fainting spells, convulsions, or epilepsy
Hearing Loss
High or low blood pressure
Nervous or mental disorder
Diabetes
Kidney or related diseases
Back injury
Alcoholism
Drug addiction or dependency
Any orthopedic problems
Are you aware of or under treatment for any physical infirmity or chronic ailment or injury of any nature which could affect your ability to train and/or jump safely?*
No
Yes

If you are aware of or are under treatment for any physical infirmity or chronic ailment or injury of any nature which could affect your ability to train and/or jump safely, please describe.
Are you under any kind of medication at the current time - or will you be under any medication when you make a skydive at Skydive Grand Haven?*

If under medication - please describe (if no - leave blank)
Do you have normal vision or wear corrective lenses?*
How did you hear about Skydive Grand Haven?
From a Friend/Family
Facebook Ad
Instagram
Flyer/poster
Radio
Google Search
Saw skydivers in Grand Haven
Tenth Participant's Name

First Name*

Middle Name

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

WEIGHT (lbs) *You will be weighed at check-in. If over 220lbs additional charges may apply. We CANNOT take jumpers weighing over 260 - please see our FAQs for additional weight information* *

HEIGHT (in ft/in) *

EMERGENCY CONTACT NAME (First and Last) *

EMERGENCY CONTACT PHONE NUMBER *
I have been treated for the following: (If you HAVE been treated for any of the following - check box) *Please note - these conditions may or may not prevent you from making a skydive*
Cardiac or pulmonary condition or disease
Fainting spells, convulsions, or epilepsy
Hearing Loss
High or low blood pressure
Nervous or mental disorder
Diabetes
Kidney or related diseases
Back injury
Alcoholism
Drug addiction or dependency
Any orthopedic problems
Are you aware of or under treatment for any physical infirmity or chronic ailment or injury of any nature which could affect your ability to train and/or jump safely?*
No
Yes

If you are aware of or are under treatment for any physical infirmity or chronic ailment or injury of any nature which could affect your ability to train and/or jump safely, please describe.
Are you under any kind of medication at the current time - or will you be under any medication when you make a skydive at Skydive Grand Haven?*

If under medication - please describe (if no - leave blank)
Do you have normal vision or wear corrective lenses?*
How did you hear about Skydive Grand Haven?
From a Friend/Family
Facebook Ad
Instagram
Flyer/poster
Radio
Google Search
Saw skydivers in Grand Haven
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*
Parent or Guardian's Driver's License / ID Card

Driver's License / ID Card Number*

Issuing State*
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

WEIGHT (lbs) *You will be weighed at check-in. If over 220lbs additional charges may apply. We CANNOT take jumpers weighing over 260 - please see our FAQs for additional weight information* *

HEIGHT (in ft/in) *

EMERGENCY CONTACT NAME (First and Last) *

EMERGENCY CONTACT PHONE NUMBER *
I have been treated for the following: (If you HAVE been treated for any of the following - check box) *Please note - these conditions may or may not prevent you from making a skydive*
Cardiac or pulmonary condition or disease
Fainting spells, convulsions, or epilepsy
Hearing Loss
High or low blood pressure
Nervous or mental disorder
Diabetes
Kidney or related diseases
Back injury
Alcoholism
Drug addiction or dependency
Any orthopedic problems
Are you aware of or under treatment for any physical infirmity or chronic ailment or injury of any nature which could affect your ability to train and/or jump safely?*
No
Yes

If you are aware of or are under treatment for any physical infirmity or chronic ailment or injury of any nature which could affect your ability to train and/or jump safely, please describe.
Are you under any kind of medication at the current time - or will you be under any medication when you make a skydive at Skydive Grand Haven?*

If under medication - please describe (if no - leave blank)
Do you have normal vision or wear corrective lenses?*
How did you hear about Skydive Grand Haven?
From a Friend/Family
Facebook Ad
Instagram
Flyer/poster
Radio
Google Search
Saw skydivers in Grand Haven
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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