Loading...

AGREEMENT AND RELEASE OF LIABILITY

1. In consideration for being permitted to utilize the facilities and equipment of Skydive Airtight, and the Skiatook Regional Airport for the purpose of SKYDIVING, PARACHUTE JUMPING, FLYING, ground instruction, competition, and other related activities, I, certifying that I am of lawful age (18 years or older), enter into the following AGREEMENT with SKYDIVE AIRTIGHT, THE UNITED STATES PARACHUTE ASSOCIATION, the TOWN OF SKIATOOK, OKLAHOMA, & STEPHEN F. STEWART. This is a legally binding contract. If you have any reservations or questions you should consult your attorney before signing this contract.

2. PARTIES INVOLVED IN THE AGREEMENTS

These AGREEMENTS are between SKYDIVE AIRTIGHT (SDA), THE UNITED STATES PARACHUTE ASSOCIATION (USPA), the TOWN OF SKIATOOK, OK, STEPHEN F. STEWART (and includes, but is not limited to, owners of equipment, instructors, jumpmasters, pilots, ground crew personnel, aircraft and land owners, ALL of their officers, employees, subcontractors, assistants, heirs, legal representatives, and assigns hereafter referred to collectively as the “Released Parties”) and myself, to include my legal representatives, spouse, family members, dependents, heirs and assigns.

3. ASSUMPTION OF RISK

I am fully aware that parachuting and skydiving activities, including ground instruction, parachute jumping, freefall, flying, and related activities are inherently dangerous; that injuries requiring professional medical care are not uncommon, and that serious injury or death can and has resulted from participation in parachuting and skydiving activities. I understand that not all the risk can be foreseen or prepared for, or avoided, to the extent that even if I do everything as I was trained to do and all the equipment functions properly, I can still be injured or killed.


4. NATURE OF PARACHUTE EQUIPMENT AND AIRCRAFT

I understand that parachutes and aircraft, and their related equipment, are designed, constructed, maintained, and operated by fallible human beings. I accept that this equipment is not warranted as safe for any purpose, and that the only assurance of quality is that all equipment and aircraft have been safely used for parachuting activities in the past, but this in no way guarantees the equipment and aircraft will function properly and safely in the future.


5. NATURE OF PARTICIPANTS IN PARACHUTING ACTIVITIES

I acknowledge that pilots, instructors, jumpmasters, radio operators, mechanics, my fellow parachutist and all others involved in parachuting are fallible human beings, and are capable of making mistakes that could result in my injury, suffering, or death.


6. VOLUNTARY NATURE OF PARTICIPATION

I agree that parachuting is of little value to society and that I am not under any compulsion to ride in or jump from an airplane. My participation is only for personal satisfaction and is entirely voluntary.


7. RELEASE FROM LIABILITY, INCLUDING NEGLIGENCE

I agree that the released parties are in no way responsible for my safety, and I release them from any and all liability for my safety whether or not I incur losses, injuries, suffering, or death as a result of their negligence, including improper action or failure to act. 


8. AGREEMENT NOT TO SUE

In consideration for being permitted to engage in parachuting activities by the released parties, I promise not to sue the released parties or make any claims against them for damages, injuries, suffering, or death, even if these are wholly or partially a result of negligence by the released parties. This agreement shall be binding on my heirs, spouse, and family members, dependents, legal representatives, and assigns, and I instruct them to abide by my agreement with the released parties, including my promise not to sue.


9. AGREEMENT TO INDEMNIFY AND HOLD HARMLESS

I agree to indemnify and hold harmless the released parties from all claims and liability, including judgments, and cost, including attorney fees, incurred in connection with any actions brought on my behalf as result of my participation in parachuting activities. Not withstanding any other provision of this contract including paragraph 8, the prevailing party in any litigation relating to this contract shall be awarded all their litigation cost and attorney fees. Including USPA and manufacturers, distributors and dealers of skydiving equipment.


10. ACCEPTANCE OF FINANCIAL RESPONSIBILITY

I understand that the released parties have no liability or personal accident insurance or general liability insurance. I agree that I am solely responsible for any expenses, medical or otherwise, that I may incur from participation in parachuting activities. I also agree that the released parties are in no way responsible to me, my spouse and family, dependents, or my heirs for any hardship from the loss of income or from expenses that may result from injuries or death. Furthermore, I agree to indemnify the released parties for any loss, liability, damage, or expense, including but not limited to personal injury or property damage that the released parties, or any third parties, may suffer as a result of my acts or omissions while participating in parachute activities. I agree I am responsible for reimbursing the released parties for damages I cause to any skydiving equipment.


11. MEDIA RELEASE

I agree that if my image appears on any film or videotape taken by the released parties, I am willing to allow the released parties to use it for publicity, informational, or entertainment purposes at no charge. I also state my willingness to be named in such materials without remuneration.


12. CONTINUATION OF OBLIGATIONS

I agree that all of the terms of this agreement apply any time now or in the future that I am engaged in parachuting and related activities with the released parties.


13. FULL CONSENT

By signing this document, I am giving up important legal rights in exchange for the opportunity to participate in parachuting and skydiving activities. I understand that this agreement can and will be used against me in a court of law, and that similar documents and agreements have been upheld in Oklahoma and most other states. However, I fully consent to all the terms of this document and am signing it with complete understanding and of my own free will. I also understand that there are many other parachute centers that offer similar services as this one, but I have chosen to engage in parachuting activities with the released parties in spite of the above warnings.


Lastly, I wish to state that I have READ the foregoing document carefully and that I FULLY UNDERSTAND IT and AGREE TO EVERYTHING CONTAINED WITHIN IT, even if I have inadvertently failed to Initial each and every clause contained within, as witness, by my signature below:

14. REGISTRATION STATEMENTS 

(listed below)

15. MEDICAL STATEMENT

1. I recognize that parachuting is a strenuous, athletic endeavor and that parachutists are subject to health risk not normally associated with other sports. I hereby certify that I do not suffer from physical or mental infirmities that could affect my ability to safely engage in parachuting or skydiving and its related activities, and that I am not under treatment for the following conditions:

1. High or low blood pressure 

2. Fainting spells or convulsions 

3. Cardiac conditions / diseases 

4. Pulmonary conditions / diseases 

5. Nervous disorders

6. Shortness of breath

7. Kidney or related diseases

8. Any other medical condition

PLEASE LIST any and all Medical Problems, past or present, which might affect your ability to “safely” skydive. (If none, ENTER "NONE" (listed below)


2. Parachuting under the influence of drugs or alcohol is prohibited by Federal Aviation Regulations and the released parties rules. I certify and declare that I am not a user of or under the influence or in any way impaired by alcohol or any drug whether legal or illegal.


3. I understand and agree that the released parties staffs are in no way qualified to offer opinions about medical conditions and how they could be affected by parachuting or skydiving.


4. In case of emergency, the following information is needed. Please leave documents such as insurance cards with a friend or keep them on your person where they can be found if necessary. Evidence of my medical qualification to skydive is evidenced by one of the following: (listed below)


16. STATEMENT OF MEDICAL INSURANCE OR LACK THEREOF

(Listed below)

Whether or not I am covered by medical insurance at this time or in the future while participating in parachuting, skydiving, and related activities with the released parties, I understand that the released parties and all related parties CARRY NO LIABILITY INSURANCE. I understand that INJURIES requiring professional medical treatment ARE NOT UNCOMMON and have and do occur while participating in parachuting, skydiving, and related activities.

17. NO REFUND POLICY

I hereby acknowledge that I understand NO REFUNDS are given. Purchasing a skydive is the same as purchasing a ticket on any other commercial aircraft. If I choose not to use the ticket after its purchase, I forfeit the ticket. If I am a “no show”, I forfeit the ticket. If I do not make arrangements, in advance, to change my reservation, I forfeit the ticket. Changes made after purchase may incur additional charges. This applies to my original reservation date, raincheck date(s) and any other subsequent skydives made at Skydive Airtight.


IN SPITE OF THE ABOVE WARNINGS ABOUT THE DANGERS OF PARACHUTING, I INTEND TO ENGAGE IN PARACHUTING, SKYDIVING, AND THEIR RELATED ACTIVITIES. THIS IS A CONSCIOUS DECISION ON MY PART AND I EXPRESSLY AND VOLUNTARILY ASSUME ALL RISK AND RESPONSIBILITY FOR INJURY AND DEATH WHILE PARTICIPATING IN PARACHUTING AND ITS RELATED ACTIVITIES.

Please Re-check this document to ensure that you have signed and initialed it in all the appropriate (shaded) places. - Thank you for your patience. - SKYDIVE AIRTIGHT

MANNING v. BRANNON
1998 OK CIV APP 17
956 P.2d 156

Date: April 29, 2024

First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information
Skydiving Status of Registrant*

Home DZ
How did you hear of us? ----- Check all that apply
Internet
Phone Book
Radio
TV
Signs
Word of mouth
Other

Other

SEX

HEIGHT

WEIGHT

Age

PLEASE LIST any and all Medical Problems, past or present, which might affect your ability to “safely” skydive. (If none, "ENTER NONE")
In case of emergency, the following information is needed. Please leave documents such as insurance cards with a friend or keep them on your person where they can be found if necessary. Evidence of my medical qualification to skydive is evidenced by one of the following: (Check ONE)
3rd Class medical certificate
Attached statement of physician
I am physically and mentally fit to skydive

Person to notify:

Phone

Alternative to notify:

Phone

Medications Currently being taken (if none – enter NONE)

Allergies to Medications
STATEMENT OF MEDICAL INSURANCE OR LACK THEREOF EITHER Statement A - OR- B (CHOOSE ONE ONLY): *
A. I am covered by medical insurance.
B. I am not covered by medical insurance.

Your current medical insurance company:

Policy holder

FOR EXPERIENCED JUMPERS ONLY


Total Number of Jumps

USPA Number*

Exp. Date

License #

*MUST be a CURRENT USPA member to jump at Skydive Airtight per our contract w/City of Skiatook, OK.


Date of last jump

Ratings

Pilot?

Type Harness/ Container Used

Type & Size of Main Parachute Used

Type & Size of Reserve Parachute Used

Last Repack Date

Type of AAD
RSL - Check one: *
No
Yes

I acknowledge that it is my RESPONSIBILITY to ensure that MY RESERVE IS IN DATE and SEALED AT ALL TIMES when I am skydiving. 

I certify that the participant asserted clear understanding of the nature and effect of the above statement. 

First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

Last Name*
Second Participant's Date of Birth*
Second Participant's Information
Skydiving Status of Registrant*

Home DZ
How did you hear of us? ----- Check all that apply
Internet
Phone Book
Radio
TV
Signs
Word of mouth
Other

Other

SEX

HEIGHT

WEIGHT

Age

PLEASE LIST any and all Medical Problems, past or present, which might affect your ability to “safely” skydive. (If none, "ENTER NONE")
In case of emergency, the following information is needed. Please leave documents such as insurance cards with a friend or keep them on your person where they can be found if necessary. Evidence of my medical qualification to skydive is evidenced by one of the following: (Check ONE)
3rd Class medical certificate
Attached statement of physician
I am physically and mentally fit to skydive

Person to notify:

Phone

Alternative to notify:

Phone

Medications Currently being taken (if none – enter NONE)

Allergies to Medications
STATEMENT OF MEDICAL INSURANCE OR LACK THEREOF EITHER Statement A - OR- B (CHOOSE ONE ONLY): *
A. I am covered by medical insurance.
B. I am not covered by medical insurance.

Your current medical insurance company:

Policy holder

FOR EXPERIENCED JUMPERS ONLY


Total Number of Jumps

USPA Number*

Exp. Date

License #

*MUST be a CURRENT USPA member to jump at Skydive Airtight per our contract w/City of Skiatook, OK.


Date of last jump

Ratings

Pilot?

Type Harness/ Container Used

Type & Size of Main Parachute Used

Type & Size of Reserve Parachute Used

Last Repack Date

Type of AAD
RSL - Check one: *
No
Yes

I acknowledge that it is my RESPONSIBILITY to ensure that MY RESERVE IS IN DATE and SEALED AT ALL TIMES when I am skydiving. 

I certify that the participant asserted clear understanding of the nature and effect of the above statement. 

Third Participant's Name

First Name*

Middle Name

Last Name*
Third Participant's Date of Birth*
Third Participant's Information
Skydiving Status of Registrant*

Home DZ
How did you hear of us? ----- Check all that apply
Internet
Phone Book
Radio
TV
Signs
Word of mouth
Other

Other

SEX

HEIGHT

WEIGHT

Age

PLEASE LIST any and all Medical Problems, past or present, which might affect your ability to “safely” skydive. (If none, "ENTER NONE")
In case of emergency, the following information is needed. Please leave documents such as insurance cards with a friend or keep them on your person where they can be found if necessary. Evidence of my medical qualification to skydive is evidenced by one of the following: (Check ONE)
3rd Class medical certificate
Attached statement of physician
I am physically and mentally fit to skydive

Person to notify:

Phone

Alternative to notify:

Phone

Medications Currently being taken (if none – enter NONE)

Allergies to Medications
STATEMENT OF MEDICAL INSURANCE OR LACK THEREOF EITHER Statement A - OR- B (CHOOSE ONE ONLY): *
A. I am covered by medical insurance.
B. I am not covered by medical insurance.

Your current medical insurance company:

Policy holder

FOR EXPERIENCED JUMPERS ONLY


Total Number of Jumps

USPA Number*

Exp. Date

License #

*MUST be a CURRENT USPA member to jump at Skydive Airtight per our contract w/City of Skiatook, OK.


Date of last jump

Ratings

Pilot?

Type Harness/ Container Used

Type & Size of Main Parachute Used

Type & Size of Reserve Parachute Used

Last Repack Date

Type of AAD
RSL - Check one: *
No
Yes

I acknowledge that it is my RESPONSIBILITY to ensure that MY RESERVE IS IN DATE and SEALED AT ALL TIMES when I am skydiving. 

I certify that the participant asserted clear understanding of the nature and effect of the above statement. 

Fourth Participant's Name

First Name*

Middle Name

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information
Skydiving Status of Registrant*

Home DZ
How did you hear of us? ----- Check all that apply
Internet
Phone Book
Radio
TV
Signs
Word of mouth
Other

Other

SEX

HEIGHT

WEIGHT

Age

PLEASE LIST any and all Medical Problems, past or present, which might affect your ability to “safely” skydive. (If none, "ENTER NONE")
In case of emergency, the following information is needed. Please leave documents such as insurance cards with a friend or keep them on your person where they can be found if necessary. Evidence of my medical qualification to skydive is evidenced by one of the following: (Check ONE)
3rd Class medical certificate
Attached statement of physician
I am physically and mentally fit to skydive

Person to notify:

Phone

Alternative to notify:

Phone

Medications Currently being taken (if none – enter NONE)

Allergies to Medications
STATEMENT OF MEDICAL INSURANCE OR LACK THEREOF EITHER Statement A - OR- B (CHOOSE ONE ONLY): *
A. I am covered by medical insurance.
B. I am not covered by medical insurance.

Your current medical insurance company:

Policy holder

FOR EXPERIENCED JUMPERS ONLY


Total Number of Jumps

USPA Number*

Exp. Date

License #

*MUST be a CURRENT USPA member to jump at Skydive Airtight per our contract w/City of Skiatook, OK.


Date of last jump

Ratings

Pilot?

Type Harness/ Container Used

Type & Size of Main Parachute Used

Type & Size of Reserve Parachute Used

Last Repack Date

Type of AAD
RSL - Check one: *
No
Yes

I acknowledge that it is my RESPONSIBILITY to ensure that MY RESERVE IS IN DATE and SEALED AT ALL TIMES when I am skydiving. 

I certify that the participant asserted clear understanding of the nature and effect of the above statement. 

Fifth Participant's Name

First Name*

Middle Name

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information
Skydiving Status of Registrant*

Home DZ
How did you hear of us? ----- Check all that apply
Internet
Phone Book
Radio
TV
Signs
Word of mouth
Other

Other

SEX

HEIGHT

WEIGHT

Age

PLEASE LIST any and all Medical Problems, past or present, which might affect your ability to “safely” skydive. (If none, "ENTER NONE")
In case of emergency, the following information is needed. Please leave documents such as insurance cards with a friend or keep them on your person where they can be found if necessary. Evidence of my medical qualification to skydive is evidenced by one of the following: (Check ONE)
3rd Class medical certificate
Attached statement of physician
I am physically and mentally fit to skydive

Person to notify:

Phone

Alternative to notify:

Phone

Medications Currently being taken (if none – enter NONE)

Allergies to Medications
STATEMENT OF MEDICAL INSURANCE OR LACK THEREOF EITHER Statement A - OR- B (CHOOSE ONE ONLY): *
A. I am covered by medical insurance.
B. I am not covered by medical insurance.

Your current medical insurance company:

Policy holder

FOR EXPERIENCED JUMPERS ONLY


Total Number of Jumps

USPA Number*

Exp. Date

License #

*MUST be a CURRENT USPA member to jump at Skydive Airtight per our contract w/City of Skiatook, OK.


Date of last jump

Ratings

Pilot?

Type Harness/ Container Used

Type & Size of Main Parachute Used

Type & Size of Reserve Parachute Used

Last Repack Date

Type of AAD
RSL - Check one: *
No
Yes

I acknowledge that it is my RESPONSIBILITY to ensure that MY RESERVE IS IN DATE and SEALED AT ALL TIMES when I am skydiving. 

I certify that the participant asserted clear understanding of the nature and effect of the above statement. 

Sixth Participant's Name

First Name*

Middle Name

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information
Skydiving Status of Registrant*

Home DZ
How did you hear of us? ----- Check all that apply
Internet
Phone Book
Radio
TV
Signs
Word of mouth
Other

Other

SEX

HEIGHT

WEIGHT

Age

PLEASE LIST any and all Medical Problems, past or present, which might affect your ability to “safely” skydive. (If none, "ENTER NONE")
In case of emergency, the following information is needed. Please leave documents such as insurance cards with a friend or keep them on your person where they can be found if necessary. Evidence of my medical qualification to skydive is evidenced by one of the following: (Check ONE)
3rd Class medical certificate
Attached statement of physician
I am physically and mentally fit to skydive

Person to notify:

Phone

Alternative to notify:

Phone

Medications Currently being taken (if none – enter NONE)

Allergies to Medications
STATEMENT OF MEDICAL INSURANCE OR LACK THEREOF EITHER Statement A - OR- B (CHOOSE ONE ONLY): *
A. I am covered by medical insurance.
B. I am not covered by medical insurance.

Your current medical insurance company:

Policy holder

FOR EXPERIENCED JUMPERS ONLY


Total Number of Jumps

USPA Number*

Exp. Date

License #

*MUST be a CURRENT USPA member to jump at Skydive Airtight per our contract w/City of Skiatook, OK.


Date of last jump

Ratings

Pilot?

Type Harness/ Container Used

Type & Size of Main Parachute Used

Type & Size of Reserve Parachute Used

Last Repack Date

Type of AAD
RSL - Check one: *
No
Yes

I acknowledge that it is my RESPONSIBILITY to ensure that MY RESERVE IS IN DATE and SEALED AT ALL TIMES when I am skydiving. 

I certify that the participant asserted clear understanding of the nature and effect of the above statement. 

Seventh Participant's Name

First Name*

Middle Name

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information
Skydiving Status of Registrant*

Home DZ
How did you hear of us? ----- Check all that apply
Internet
Phone Book
Radio
TV
Signs
Word of mouth
Other

Other

SEX

HEIGHT

WEIGHT

Age

PLEASE LIST any and all Medical Problems, past or present, which might affect your ability to “safely” skydive. (If none, "ENTER NONE")
In case of emergency, the following information is needed. Please leave documents such as insurance cards with a friend or keep them on your person where they can be found if necessary. Evidence of my medical qualification to skydive is evidenced by one of the following: (Check ONE)
3rd Class medical certificate
Attached statement of physician
I am physically and mentally fit to skydive

Person to notify:

Phone

Alternative to notify:

Phone

Medications Currently being taken (if none – enter NONE)

Allergies to Medications
STATEMENT OF MEDICAL INSURANCE OR LACK THEREOF EITHER Statement A - OR- B (CHOOSE ONE ONLY): *
A. I am covered by medical insurance.
B. I am not covered by medical insurance.

Your current medical insurance company:

Policy holder

FOR EXPERIENCED JUMPERS ONLY


Total Number of Jumps

USPA Number*

Exp. Date

License #

*MUST be a CURRENT USPA member to jump at Skydive Airtight per our contract w/City of Skiatook, OK.


Date of last jump

Ratings

Pilot?

Type Harness/ Container Used

Type & Size of Main Parachute Used

Type & Size of Reserve Parachute Used

Last Repack Date

Type of AAD
RSL - Check one: *
No
Yes

I acknowledge that it is my RESPONSIBILITY to ensure that MY RESERVE IS IN DATE and SEALED AT ALL TIMES when I am skydiving. 

I certify that the participant asserted clear understanding of the nature and effect of the above statement. 

Eighth Participant's Name

First Name*

Middle Name

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information
Skydiving Status of Registrant*

Home DZ
How did you hear of us? ----- Check all that apply
Internet
Phone Book
Radio
TV
Signs
Word of mouth
Other

Other

SEX

HEIGHT

WEIGHT

Age

PLEASE LIST any and all Medical Problems, past or present, which might affect your ability to “safely” skydive. (If none, "ENTER NONE")
In case of emergency, the following information is needed. Please leave documents such as insurance cards with a friend or keep them on your person where they can be found if necessary. Evidence of my medical qualification to skydive is evidenced by one of the following: (Check ONE)
3rd Class medical certificate
Attached statement of physician
I am physically and mentally fit to skydive

Person to notify:

Phone

Alternative to notify:

Phone

Medications Currently being taken (if none – enter NONE)

Allergies to Medications
STATEMENT OF MEDICAL INSURANCE OR LACK THEREOF EITHER Statement A - OR- B (CHOOSE ONE ONLY): *
A. I am covered by medical insurance.
B. I am not covered by medical insurance.

Your current medical insurance company:

Policy holder

FOR EXPERIENCED JUMPERS ONLY


Total Number of Jumps

USPA Number*

Exp. Date

License #

*MUST be a CURRENT USPA member to jump at Skydive Airtight per our contract w/City of Skiatook, OK.


Date of last jump

Ratings

Pilot?

Type Harness/ Container Used

Type & Size of Main Parachute Used

Type & Size of Reserve Parachute Used

Last Repack Date

Type of AAD
RSL - Check one: *
No
Yes

I acknowledge that it is my RESPONSIBILITY to ensure that MY RESERVE IS IN DATE and SEALED AT ALL TIMES when I am skydiving. 

I certify that the participant asserted clear understanding of the nature and effect of the above statement. 

Ninth Participant's Name

First Name*

Middle Name

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information
Skydiving Status of Registrant*

Home DZ
How did you hear of us? ----- Check all that apply
Internet
Phone Book
Radio
TV
Signs
Word of mouth
Other

Other

SEX

HEIGHT

WEIGHT

Age

PLEASE LIST any and all Medical Problems, past or present, which might affect your ability to “safely” skydive. (If none, "ENTER NONE")
In case of emergency, the following information is needed. Please leave documents such as insurance cards with a friend or keep them on your person where they can be found if necessary. Evidence of my medical qualification to skydive is evidenced by one of the following: (Check ONE)
3rd Class medical certificate
Attached statement of physician
I am physically and mentally fit to skydive

Person to notify:

Phone

Alternative to notify:

Phone

Medications Currently being taken (if none – enter NONE)

Allergies to Medications
STATEMENT OF MEDICAL INSURANCE OR LACK THEREOF EITHER Statement A - OR- B (CHOOSE ONE ONLY): *
A. I am covered by medical insurance.
B. I am not covered by medical insurance.

Your current medical insurance company:

Policy holder

FOR EXPERIENCED JUMPERS ONLY


Total Number of Jumps

USPA Number*

Exp. Date

License #

*MUST be a CURRENT USPA member to jump at Skydive Airtight per our contract w/City of Skiatook, OK.


Date of last jump

Ratings

Pilot?

Type Harness/ Container Used

Type & Size of Main Parachute Used

Type & Size of Reserve Parachute Used

Last Repack Date

Type of AAD
RSL - Check one: *
No
Yes

I acknowledge that it is my RESPONSIBILITY to ensure that MY RESERVE IS IN DATE and SEALED AT ALL TIMES when I am skydiving. 

I certify that the participant asserted clear understanding of the nature and effect of the above statement. 

Tenth Participant's Name

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information
Skydiving Status of Registrant*

Home DZ
How did you hear of us? ----- Check all that apply
Internet
Phone Book
Radio
TV
Signs
Word of mouth
Other

Other

SEX

HEIGHT

WEIGHT

Age

PLEASE LIST any and all Medical Problems, past or present, which might affect your ability to “safely” skydive. (If none, "ENTER NONE")
In case of emergency, the following information is needed. Please leave documents such as insurance cards with a friend or keep them on your person where they can be found if necessary. Evidence of my medical qualification to skydive is evidenced by one of the following: (Check ONE)
3rd Class medical certificate
Attached statement of physician
I am physically and mentally fit to skydive

Person to notify:

Phone

Alternative to notify:

Phone

Medications Currently being taken (if none – enter NONE)

Allergies to Medications
STATEMENT OF MEDICAL INSURANCE OR LACK THEREOF EITHER Statement A - OR- B (CHOOSE ONE ONLY): *
A. I am covered by medical insurance.
B. I am not covered by medical insurance.

Your current medical insurance company:

Policy holder

FOR EXPERIENCED JUMPERS ONLY


Total Number of Jumps

USPA Number*

Exp. Date

License #

*MUST be a CURRENT USPA member to jump at Skydive Airtight per our contract w/City of Skiatook, OK.


Date of last jump

Ratings

Pilot?

Type Harness/ Container Used

Type & Size of Main Parachute Used

Type & Size of Reserve Parachute Used

Last Repack Date

Type of AAD
RSL - Check one: *
No
Yes

I acknowledge that it is my RESPONSIBILITY to ensure that MY RESERVE IS IN DATE and SEALED AT ALL TIMES when I am skydiving. 

I certify that the participant asserted clear understanding of the nature and effect of the above statement. 

Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
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(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.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information
Skydiving Status of Registrant*

Home DZ
How did you hear of us? ----- Check all that apply
Internet
Phone Book
Radio
TV
Signs
Word of mouth
Other

Other

SEX

HEIGHT

WEIGHT

Age

PLEASE LIST any and all Medical Problems, past or present, which might affect your ability to “safely” skydive. (If none, "ENTER NONE")
In case of emergency, the following information is needed. Please leave documents such as insurance cards with a friend or keep them on your person where they can be found if necessary. Evidence of my medical qualification to skydive is evidenced by one of the following: (Check ONE)
3rd Class medical certificate
Attached statement of physician
I am physically and mentally fit to skydive

Person to notify:

Phone

Alternative to notify:

Phone

Medications Currently being taken (if none – enter NONE)

Allergies to Medications
STATEMENT OF MEDICAL INSURANCE OR LACK THEREOF EITHER Statement A - OR- B (CHOOSE ONE ONLY): *
A. I am covered by medical insurance.
B. I am not covered by medical insurance.

Your current medical insurance company:

Policy holder

FOR EXPERIENCED JUMPERS ONLY


Total Number of Jumps

USPA Number*

Exp. Date

License #

*MUST be a CURRENT USPA member to jump at Skydive Airtight per our contract w/City of Skiatook, OK.


Date of last jump

Ratings

Pilot?

Type Harness/ Container Used

Type & Size of Main Parachute Used

Type & Size of Reserve Parachute Used

Last Repack Date

Type of AAD
RSL - Check one: *
No
Yes

I acknowledge that it is my RESPONSIBILITY to ensure that MY RESERVE IS IN DATE and SEALED AT ALL TIMES when I am skydiving. 

I certify that the participant asserted clear understanding of the nature and effect of the above statement. 

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 - TRY IT FREE!