PRIVACY POLICY
WHAT INFORMATION DO WE COLLECT?
We collect information from you when you register on our site, place an order, subscribe to our newsletter, respond to a survey or fill out a form. When ordering or registering on our site, as appropriate, you may be asked to enter your: name, e-mail address, mailing address, phone number or credit card information.

WHAT DO WE USE YOUR INFORMATION FOR?
Any of the information we collect from you may be used in one of the following ways:

To personalize your experience. Your information helps us to better respond to your individual needs.
To improve our website. We continually strive to improve our website offerings based on the information and feedback we receive from you.
To improve customer service. Your information helps us to more effectively respond to your customer service requests and support needs.
To process transactions. Your information, whether public or private, will not be sold, exchanged, transferred, or given to any other company for any reason whatsoever, without your consent, other than for the express purpose of delivering the purchased product or service requested.
To administer a contest, promotion, survey or other site feature
To send periodic emails
The email address you provide for order processing will only be used to send you information and updates pertaining to your order.
If you decide to opt-in to our mailing list, you will receive emails that may include company news, updates, related product or service information, etc.
Note: If at any time you would like to unsubscribe from receiving future emails, we include detailed unsubscribe instructions at the bottom of each email.
HOW DO WE PROTECT YOUR INFORMATION?
We implement a variety of security measures to maintain the safety of your personal information when you place an order or access your personal information.

We offer the use of a secure server. All supplied sensitive/credit information is transmitted via Secure Socket Layer (SSL) technology and then encrypted into our Payment gateway providers database only to be accessible by those authorized with special access rights to such systems, and are required to keep the information confidential. After a transaction, your private information (credit cards, financials, etc.) will not be stored on our servers.

DO WE USE COOKIES?
Yes. Cookies are small files that a site or its service provider transfers to your computer’s hard drive through your Web browser (if you allow) that enables the sites or service providers systems to recognize your browser and capture and remember certain information
We use cookies to understand and save your preferences for future visits and compile aggregate data about site traffic and site interaction so that we can offer better site experiences and tools in the future.

DO WE DISCLOSE ANY INFORMATION TO OUTSIDE PARTIES?
We do not sell, trade, or otherwise transfer to outside parties your personally identifiable information.
This does not include trusted third parties who assist us in operating our website, conducting our business, or servicing you, so long as those parties agree to keep this information confidential. We may also release your information when we believe release is appropriate to comply with the law, enforce our site policies, or protect ours or others rights, property, or safety. However, non-personally identifiable visitor information may be provided to other parties for marketing, advertising, or other uses.

THIRD PARTY LINKS
Occasionally, at our discretion, we may include or offer third party products or services on our website. These third party sites have separate and independent privacy policies. We, therefore, have no responsibility or liability for the content and activities of these linked sites. Nonetheless, we seek to protect the integrity of our site and welcome any feedback about these sites.

ONLINE PRIVACY POLICY ONLY
This online privacy policy applies only to information collected through our website and not to information collected offline.

Controlling your personal information

You may choose to restrict the collection or use of your personal information in the following ways:

Whenever you are asked to fill in a form on the website, look for the box that you can click to indicate that you do not want the information to be used by anybody for direct marketing purposes
If you have previously agreed to us using your personal information for direct marketing purposes, you may change your mind at any time by writing to or emailing us at Skydive@HarveyField.com
We will not sell, distribute or lease your personal information to third parties unless we have your permission or are required by law. We may use your personal information to send you promotional information about third parties which we think you may find interesting if you tell us that you wish this to happen.
You may request details of personal information which we hold about you under the Data Protection Act 1998. A small fee will be payable. If you would like a copy of the information held on you please write to Skydive Snohomish at 9906 Airport Way Snohomish, WA 98296.

If you believe that any information we are holding on you is incorrect or incomplete, please write to or email us as soon as possible, at the above address. We will promptly correct any information found to be incorrect.

TERMS AND CONDITIONS
Please also visit our Terms and Conditions section establishing the use, disclaimers, and limitations of liability governing the use of our website at: https://www.skydivesnohomish.com/terms.

By using our site, you consent to our privacy policy.

CHANGES TO OUR PRIVACY POLICY
If we decide to change our privacy policy, we will post those changes on this page.

This policy was last modified on June 2, 2017.

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LICENSED SKYDIVER  Waiver/Contract

with Registration and Drop Zone Rules 


Review Skydive Snohomish Privacy Policy

Where signatures are required, please sign your name the same way as on your government-issued photo ID.  "X" or lines are not acceptable.

 

Skydive Snohomish, Inc

Drop Zone Rules and Requirements

Listed below are the general rules for unsupervised jump privileges at Skydive Snohomish, Inc.

  1. Jump FAA approved equipment; the reserve parachute having been packed by an FAA certified rigger within the past 180 days.
  2. Possess at least a "C" or "D” license.
  3. Must have completed a formal sport parachuting course. 
  4. Refrain from skydiving or flying for at least 24 hours after scuba diving.
  5. Agree to honor the minimum 3,000’ main parachute deployment altitude.
  6. Refrain from the use of alcohol during jump operations and for at least 8 hours before coming onto airport property.
  7. Refrain from hook turns/high performance landings and understand that hook turns/high performance landings are highly discouraged.
  8. Meet USPA Currency Requirements for license held (180 days).
  9. Meet Medical Requirements of BSR 2-1.03.
  10. Be familiar and comply with all appropriate Federal Aviation Regulations, (FARS), United States Parachute Association Basic Safety Requirements, (BSR’s), the Skydiver Information Manual, (SIM), Harvey (S43) Airport Rules and Regulations, and all Federal, State, and Local Regulations pertaining to skydiving. 
  11. “C” and "D" licensed skydivers with at least 200 skydives and tandems may land on the airport.

Aircraft Loading:   When the aircraft is running you are required to board immediately without further dirt dives. Always approach the aircraft from the rear, do not travel beyond the wing strut when approaching from the rear, and take extreme caution to avoid the propeller whether it is spinning or not. Load the aircraft with the lightest jumper in the center rear facing forward, the second jumper facing forward next to the rear of the jump door. The third jumper facing rear with back to the pilot’s seat and the fourth jumper seated back to the instrument panel next to the pilot. The heaviest jumpers should be in the middle of the aircraft cabin.  

Aircraft Seatbelts:   The FAR’s (Federal Aviation Regulations) mandate the use of seatbelts in the aircraft and we insist on it. We suggest that you fasten the belt through your harness main lift web if facing rear. Please do not undo your seatbelt and lean forward of the pilot on takeoff. In the event of a forced landing it is critical that you be restrained. Remove seatbelt at 1,500 feet.  
USPA Insurance and Membership:   To guarantee USPA insurance coverage you must be a current member of USPA and possess an appropriate license. No exceptions. Proof is required. 

Outside Commerce:   Outside commerce or its solicitation is prohibited at Skydive Snohomish and Harvey Airfield without prior written authorization. 
Insurance:   Our transportation carries no insurance of any kind, specifically no liability insurance. In the event of accident, injury or death, you must agree not to sue the owners of the transportation or the driver for any reason whatsoever, including negligence. 
Hookturns / High Performance Landings:   A hookturn or high performance landing is any landing involving more than a 90 degree turn from base to final approach. These landings can be extremely dangerous and we do not endorse performing them at any time. It is the responsibility of every jumper to fly an appropriate landing approach and to land the parachute in a safe manner. Any deviation will result in your immediate grounding, effective for as long as deemed needed by the grounding official. This decision is left solely to management, staff, and USPA representatives who may be present at the time, and is not subject to discussion or appeal on the part of the jumper, so make sure that your landing is not only safe but appears to be safe, too.
Airport Approach Patterns for Landing:   Descend to the east of the runways regardless of the freefall and opening point. Do not attempt to cross the runways lower than 1,000 feet AGL. Once east of the runways, achieve good vertical separation and fly a definite pattern for landing. If unable to cross the runway higher than 1,000 feet you must abort and land, west of the paved & grass runways. The airport rules are: 

  • DO NOT do spiral turns except when achieving vertical separation.
  • DO NOT shoot an accuracy approach that stacks up everyone behind you.
  • DO NOT do hook turn or high performance landings.
  • DO land well within the landing “triangle” defined by runway, north taxiway and east taxiway.

I UNDERSTAND AND AGREE TO THE RULES ABOVE. 

I Agree

   September 18, 2021

Skydive Snohomish Jumper DZ Requirements

  1. Currency Requirements
    1. C License:  1 jump within the past 180 days
    2. D License:  1 jump within the past 180 days
  2. Credentials On File
    1. Copy of valid Government-issued picture ID
    2. Copy of USPA Individual membership and C or D license
    3. Copy of a signed logbook entry, validating currency (180 days)
    4. Signed Waiver Contract Agreement 
    5. Copy of “one” of the three BSR Medical Requirements (see below)
  3. Medical Requirements:  BSR2-1.03 1.
    1. Carry a valid, class one, two, or three FAA Medical Certificate; or
    2. Carry a certificate of physical fitness for skydiving from registered physician; or 
    3. Have read and signed the USPA Medical Statement.  (Located in Contract, item #15)
  4. Reserve Requirements
    1. Licensed skydivers who own equipment must use harness container systems that are manufactured under the appropriate FAA TSO and possess documentation (data card signed and dated by an FAA Certified Rigger – sealed reserve) proving a reserve inspection and repack by an FAA Certified Parachute Rigger within the past 180 days.
  5. Pre-Jump Requirements:  BSR2-1.09
    1. The appropriate altitude and surface winds are to be determined prior to any skydive.
  6. Minimum Opening Altitudes:  BSR2-1.07
    1. Tandem jumps:  5000 ft AGL
    2. C & D License Holders:  Snohomish DZ Minimum Opening is 3000’ for C & D License
  7. Compliance with Federal Regulations:  BSR2-1.02 No skydive shall be made in violation of Federal Aviation Administration (FAA) regulations.  This includes the use of restraint systems in the aircraft by all skydivers during movement on the surface, take-off and landing. 

I have read, understand and agree to the Skydive Snohomish, Inc. Jumper Drop Zone Requirements. 

I Agree

   September 18, 2021

 

Explanation of CONTRACT NOT TO SUE INCLUDING NEGLIGENCE 

These are the unavoidable facts of skydiving life: 

  1. Pilots, riggers, staff and aircraft mechanics are human beings who can make mistakes.
  2. Your gear has been designed and built by humans, making it very susceptible to malfunction. Your imperfect equipment can hurt or seriously kill you in ways you haven’t even thought of.
  3. You can get injured or killed while skydiving, while in the aircraft trying to skydive, or by getting hit by a landing jumper. The ways to be injured or killed are limitless. 

Jumping out of an airplane is dangerous:   Typical skydiving injuries consist of; broken legs, broken ankles, broken wrists or fingers, back injuries, injuries of all sorts (including death) from hitting obstacles such as power lines, trees, roadways or water, and death from hitting the ground too hard because your parachute didn’t work correctly, you handled it incorrectly, or the airplane you were riding in stopped flying for any one of innumerable reasons. By involving yourself in this activity you may be hurt, killed or receive a disabling injury, which could cause you to spend the remainder of your life in a wheelchair or similar apparatus. It is also possible that you could receive cosmetic injuries that could result in the change of your appearance, walk, posture or mobility. By jumping here we are not guaranteeing that your jump will be injury-free. By observing our policies and procedures we are only working to minimize the possibility of injury or death.


Standard of Care for the Aircraft and Pilots:  We provide skydiving instruction and the opportunity to skydive as our principle form of business. We provide a lift to jump altitude, a trip from point A to point B, with the aircraft ride to jump altitude being incidental to the business of skydiving. Therefore, all of our jump aircraft and pilot training guidelines fall under Part 91 of the FAR’s. The fee you pay for jumping consists of a fee for training (if training is used), a landing fee, and the sharing of expenses of the aircraft. All of these activities are allowable under FAR Part 91. Commercial airlines whose prime business is the providing of aircraft transportation from point A to Point B are licensed under FAR Part 135, which requires a much higher standard of care for both the aircraft and the pilot training. 

CONTRACT NOT TO SUE INCLUDING NEGLIGENCE 
WARNING: Read each paragraph carefully. By signing this contract you are agreeing to give up certain legal rights. Carefully read and understand the entire contract. After you read each paragraph please initial on the line provided. Your initials indicate you understand and agree to be bound by all of the terms contained therein.

In consideration of Harvey Airfield, Inc. and Skydive Snohomish, Inc. allowing me the privilege of using their skydiving facilities and granting the opportunity to skydive from their and their contractor’s aircraft, I agree to be bound by the following: 

  1. Comprehension:  I can read, write and understand the English language. 
    I Agree
  2. Free Will:  I have come to Skydive Snohomish of my own free will and am inducing the owners and staff of Skydive Snohomish to allow me to skydive here by paying money and signing this legally binding contract. I agree that if I do not pay or sign this contract I will not be allowed to jump here. I understand that I can go elsewhere to jump if I do not agree to these terms. I have not been forced in any way to agree to or sign this document, and am doing so because I am willing to accept all risks associated with skydiving in order to jump at Skydive Snohomish.   
    I Agree
     
  3. Credentials:  I am an experienced USPA C or D licensed skydiver who has completed a formal course of instruction in skydiving and sport parachuting. The entries in my logbook are true and correct and can be relied upon to verify my true jump number and experience.    
    I Agree
  4. No Insurance Coverage:  I understand that Skydive Snohomish carries no insurance: no medical insurance, no liability insurance, no property damage insurance and no wage insurance. I agree that if I am hurt or killed, neither I, nor my survivors, can look to Skydive Snohomish for payment of any sort.    
    I Agree
     
  5. CORONAVIRUS (COVID-19) and Skydiving: Skydiving in general, requires close contact with other participants. We have taken extra measures to reduce the potential COVID-19 exposure to/by our staff and customers, but Skydive Snohomish cannot eliminate the risk of exposure or guarantee your protection. By participating in skydiving, in addition to all the other risks you have been made aware of by our waiver and website, you assume all responsibility for the exposure/transmission and risk of contracting COVID-19. If you cannot accept those risks, then you should not participate in skydiving activities with us right now. For more information about the risks of COVID-19 and transmission, please see www.cdc.gov. 
    I Agree
  6. Contract Not To Sue:  I will not file, nor caused to be filed, nor participate in any lawsuit against Skydive Snohomish for injuries sustained as a result of skydiving. I specifically agree not to sue even in the event of negligence.    
    I Agree
  7. Seat Belts:  I agree to be responsible for locating and using my seat belt while in the jump aircraft at all altitudes below 1,000 feet and in any Skydive Snohomish vehicles while in motion.    
    I Agree
  8. RSL & AAD Recommended:  Skydive Snohomish management strongly recommends the use of a Reserve Static Line (RSL) and Automatic Activation Device (AAD). If I choose not to use these items I understand that I incur a statistically higher probability of being injured or killed while skydiving.   
    I Agree
  9. Use of the Airport:  I understand that in order for me to land at the airport I must be a member of USPA and possess a valid, current C license or higher. I understand that USPA insurance DOES NOT cover physical damage to Skydive Snohomish aircraft or facilities. I agree to reimburse Skydive Snohomish for any such damage to aircraft or facilities that I may cause and is not covered by USPA insurance.   
    I Agree
  10. Representations, Warranties & Assumptions of Risk:  I know and understand the scope, nature and extent of the risks involved in skydiving. I understand that parachute jumping exposes me to the risk of personal injury, property damage and death. I understand that the success of my jump is dependent upon the perfect functioning of the airplane and the parachute system, neither of which can be guaranteed to function perfectly. I fully understand that the airplane and the parachute system are both subject to mechanical malfunction as well as operator error. I freely, voluntarily, and expressly choose to assume all risks inherent in parachute jumping. Including, but not limited to, risks of equipment malfunction and failure to function. Including those which may result from defects in design, assembly, or manufacture, as well as those risks arising from improper or negligent operation or use of the equipment, for the thrill of participating in this activity, understanding full well that those risks may include personal injury, property damage, and death.   
    I Agree
  11. Exemption and Release from Liability:  I CLEARLY understand that skydiving is a dangerous, calculated risk activity which CAN and sometimes DOES result in bodily injury to its participants. I am freely accepting these risks in trade for the thrill of skydiving understanding full well that those risks may include personal injury, property damage and/or death. I therefore exempt, release and discharge Skydive Snohomish, Inc. Harvey Airfield, Inc., airport property owners and individuals, Kandace A. Harvey-Stiffler, Philip M. Stiffler, Lance N. Harvey, Heather A. Waldo, Preston J. Harvey, and Tyson M. Harvey, all individuals, both corporately and individually, Harvey Airfield, Inc. and its agents, employees and representatives, Raven Aero LLC, its members, owners, pilots, and mechanics, Snohomish Flying Service, its members, owners, pilots, and mechanics, Kapowsin Airsports, its members, owners, pilots, and mechanics, Uninsured United Parachute Technologies, LLC, dba UPT Vector, their corporations, officers, directors, agents, servants, employees, shareholders, manufacturers, designers, and suppliers of component equipment used in the dual-harness, dual-container parachute pack assembly, the United States Parachute Association, and any other equipment manufacturer. I further release and discharge all instructors, pilots, jumpmasters, riggers, drivers, officers, directors, agents, employees and members as well as the owners of the aircraft, motor vehicles, boats, land and equipment utilized for skydiving and related activities, including ground and water transportation therewith, and any other property owner upon whose property I may land or attempt to land and anyone else assisting me in my attempt to skydive including all independent contractors and/or employees of all entities listed above. This release is hereby expanded to include any and all liability, claims, demands or actions, or causes of actions whatsoever arising out of any damage, loss or injury to me or my property, or my death whether occurring while I am preparing for my skydive, in the aircraft, while jumping, or engaged in all related activities whether such loss, damage, injury, or death results from the negligence or other fault, either active or passive, of any of the persons or organizations in any way associated with Skydive Snohomish, or from any other cause. This agreement also includes its officers and agents as well as all manufacturers, designers, dealers, distributors and suppliers of aircraft and parachute equipment/components used during my intentional parachute jumps.  I further release and discharge any property owner upon whose property I may land or attempt to land including Harvey Airfield, Inc., DK Legacy LLC, Kandace Harvey-Stiffler, both corporately and individually, Bartelheimer Bros. Inc., and its agents, employees and representatives, All About Auto Wrecking LLC, and its agents, employees and representatives, and the French Slough Partnership, individually, their agents, contractors, owners and employees and everyone else including all independent contractors and/or employees of all entities listed above, hereinafter referred to as “Named Parties Released”.  I hereby extend this contract addendum to include any and all actions that may be undertaken at the behest of my heirs, administrators or any other person with legal standing.    
    I Agree
  12. Covenant Not to Sue:  I agree that I will not file, nor cause to be filed, nor participate in any lawsuit against the above Named Parties Released for injuries or death sustained as a result of skydiving or training. I have been told in advance that skydiving is a very dangerous activity and that I can get hurt or killed while doing it.  I agree not to sue even in the event of negligence. I also agree that my heirs, executors, administrators, personal representatives, or anyone else claiming on my behalf, shall not institute any lawsuit, cause of action, or claim for damages against any of the Named Parties Released, nor shall they initiate or assist in the prosecution of any claim for damages against the Named Parties Released which I, my heirs, executors, administrators, personal representatives and/or anyone else claiming on my behalf may have by reason in injury to my person or property, or my death, arising from activities covered by this Waiver/Contract, whether caused by the negligence of fault, either active or passive, of any of the Named Parties Released, or from any other cause. I hereby so instruct my heirs, executors, administrators, personal representatives, or anyone else acting on my behalf. Should any lawsuit or cause of action arising from this agreement/activity be instituted against any of the Named Parties Released, I agree they shall be entitled to recover (from me or my estate) actual attorney’s fees and costs incurred in the defense of such lawsuit or cause of action, including any appeal arising therefrom.   
    I Agree
  13. Indemnity Against Third Party Claims:  I will indemnify (reimburse), save and hold harmless Skydive Snohomish and any persons or businesses in any way associated with Skydive Snohomish 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 persons and/or organizations and which arise directly or indirectly from my participation in the activities covered by the Contract, whether resulting from the negligence and/or other fault, either active or passive, or any of the organizations and/or persons in any way associated with Skydive Snohomish, or from any other cause.   
    I Agree
  14. Validity of Contract:  I understand 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 the organizations and/or persons in any way associated with Skydive Snohomish because of injury to my person or property, or my death, due to the activities covered by this Contract, this Contract can and will be used in court. Such contracts have been upheld in courts in similar circumstances.   
    I Agree
  15. Representations as to Medical Condition:  I represent that my physical and mental conditions are appropriate to deal with the rigors of sport parachuting and skydiving. I understand that Skydive Snohomish does not employ a doctor for medical advice and that it is my full and final responsibility to determine my physical and mental condition prior to each and every jump. I hereby fully release any and all entities associated with Skydive Snohomish from injuries or death, which I may suffer as a result from any physical or mental infirmary that I may have. “I the participant represent and warrant that I have no physical infirmities or disabilities, am not under treatment for any physical infirmity or chronic ailment, or injury of any nature; and that 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, kidney or related diseases, high or low blood pressure, or any other disability which might in any way affect my ability to participate in skydiving”.   
    I Agree
  16. Waiver of Jury Trial Applicable Law/Venue/Headings:  I agree that the law of the State of Washington shall apply to issues involving the construction, interpretation, and validity of this contract, and that Washington law shall govern any dispute between the parties arising from the activities covered by this contract. In the event this contract not to sue including negligence is violated and suit is brought against Skydive Snohomish or any of the organizations and/or persons in any way associated with Skydive Snohomish, I waive my right to a jury trial, and agree that Snohomish County, Washington shall have jurisdiction and venue over this agreement and matter.  I understand that the headings and the sub-headings used throughout this Contract are for convenience only and have no significance in the interpretation of the body of this Contract.   
    I Agree
  17. Severability/Multiple Waivers:  I agree that should one or more provisions in this contract/waiver be found judicially to be unenforceable, the remaining provisions shall continue to be binding and enforceable against me. If I have executed any other contract/waiver containing provisions, relating to the exemption and/or release from liability, and/or contract not to sue, in connection with the activities covered by this contract, I agree that the contract/waiver which provides most protection from liability and/or suit to Harvey Airfield, Inc. Inc., or Skydive Snohomish, Inc. will be enforceable against me.   
    I Agree
  18. Media Release:  agree that if my image or voice appears on any picture or video taken at Skydive Snohomish, Inc. I am willing to allow Skydive Snohomish, Inc. to use it as well as my name for publicity, informational, or whatever purpose they deem appropriate without expectation of payment and grant them a gratuitous license therewith.   
    I Agree
  19. Continuation of Obligations:  I agree and acknowledge that the terms and conditions of this contract shall continue in force and effect now and in the future at all times during which I participate in the activities covered by this contract, and shall be binding upon my heirs, executors, administrators, personal representatives, and/or anyone else claiming on my behalf. This contract supersedes any prior contract I have signed.   
    I Agree
           

SIGNATURE OF JUMPER

Signing this contract certifies that I have read this contract carefully, completely, and understand this contract in its entirety.  I freely and voluntarily agree to all of the above and everything in this contract by signing this contract on September 18, 2021.

 

   September 18, 2021

 

CONTACT INFORMATION INSTRUCTIONS 

STOP!  Please follow these instructions and complete your waiver carefully.   Once completed, your waiver cannot be edited.  If it contains errors you will have to fill it out again. 
Participant's Name, Date of Birth, and ID#:MUST MATCH Photo ID EXACTLY
Participant's Address: Please use a current US address. If staying in the US temporarily, use the address where you are staying. 
Emergency Contact: Please provide the name and phone number of a person who is in the US, and does not skydive with you. 

First Participant's Name

First Name*

Middle Name

Last Name*

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

Current Weight (in pounds) *
Are you under 6ft tall?*
Yes
No

USPA # *

USPA License # *

USPA License Expiration Date *

Last Reserve Repack date *

Container Make and Model *

Main Canopy Make, Model, and Size *

Reserve Make, Model, and Size *

Date of last jump *

Number of jumps *
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

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

Current Weight (in pounds) *
Are you under 6ft tall?*
Yes
No

USPA # *

USPA License # *

USPA License Expiration Date *

Last Reserve Repack date *

Container Make and Model *

Main Canopy Make, Model, and Size *

Reserve Make, Model, and Size *

Date of last jump *

Number of jumps *
Third Participant's Name

First Name*

Middle Name

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

Current Weight (in pounds) *
Are you under 6ft tall?*
Yes
No

USPA # *

USPA License # *

USPA License Expiration Date *

Last Reserve Repack date *

Container Make and Model *

Main Canopy Make, Model, and Size *

Reserve Make, Model, and Size *

Date of last jump *

Number of jumps *
Fourth Participant's Name

First Name*

Middle Name

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

Current Weight (in pounds) *
Are you under 6ft tall?*
Yes
No

USPA # *

USPA License # *

USPA License Expiration Date *

Last Reserve Repack date *

Container Make and Model *

Main Canopy Make, Model, and Size *

Reserve Make, Model, and Size *

Date of last jump *

Number of jumps *
Fifth Participant's Name

First Name*

Middle Name

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

Current Weight (in pounds) *
Are you under 6ft tall?*
Yes
No

USPA # *

USPA License # *

USPA License Expiration Date *

Last Reserve Repack date *

Container Make and Model *

Main Canopy Make, Model, and Size *

Reserve Make, Model, and Size *

Date of last jump *

Number of jumps *
Sixth Participant's Name

First Name*

Middle Name

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

Current Weight (in pounds) *
Are you under 6ft tall?*
Yes
No

USPA # *

USPA License # *

USPA License Expiration Date *

Last Reserve Repack date *

Container Make and Model *

Main Canopy Make, Model, and Size *

Reserve Make, Model, and Size *

Date of last jump *

Number of jumps *
Seventh Participant's Name

First Name*

Middle Name

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

Current Weight (in pounds) *
Are you under 6ft tall?*
Yes
No

USPA # *

USPA License # *

USPA License Expiration Date *

Last Reserve Repack date *

Container Make and Model *

Main Canopy Make, Model, and Size *

Reserve Make, Model, and Size *

Date of last jump *

Number of jumps *
Eighth Participant's Name

First Name*

Middle Name

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

Current Weight (in pounds) *
Are you under 6ft tall?*
Yes
No

USPA # *

USPA License # *

USPA License Expiration Date *

Last Reserve Repack date *

Container Make and Model *

Main Canopy Make, Model, and Size *

Reserve Make, Model, and Size *

Date of last jump *

Number of jumps *
Ninth Participant's Name

First Name*

Middle Name

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

Current Weight (in pounds) *
Are you under 6ft tall?*
Yes
No

USPA # *

USPA License # *

USPA License Expiration Date *

Last Reserve Repack date *

Container Make and Model *

Main Canopy Make, Model, and Size *

Reserve Make, Model, and Size *

Date of last jump *

Number of jumps *
Tenth Participant's Name

First Name*

Middle Name

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

Current Weight (in pounds) *
Are you under 6ft tall?*
Yes
No

USPA # *

USPA License # *

USPA License Expiration Date *

Last Reserve Repack date *

Container Make and Model *

Main Canopy Make, Model, and Size *

Reserve Make, Model, and Size *

Date of last jump *

Number of jumps *
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*
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

Current Weight (in pounds) *
Are you under 6ft tall?*
Yes
No

USPA # *

USPA License # *

USPA License Expiration Date *

Last Reserve Repack date *

Container Make and Model *

Main Canopy Make, Model, and Size *

Reserve Make, Model, and Size *

Date of last jump *

Number of jumps *
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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