Student Jumper Waiver

October 22, 2024

* Temporarily clogged ears are common after a skydive, but if you have a stuffed up head use caution! If you cannot breathe through your nose, the rapid pressure change of an extended free fall can result in extreme pain or even a broken eardrum.

AGREEMENT AND RELEASE OF LIABILITY

In consideration for being permitted to utilize the facilities and equipment of PA Skydive Center, Inc. dba Above the Poconos Skydivers and to engage in parachute jumping, ground instruction, flying and related activities hereinafter collectively referred to as “parachuting activities,” I certify I am at least 18 years of age and HEREBY AGREE AS FOLLOWS:

1) I understand and acknowledge that parachuting activities involve danger to me and can cause serious and fatal injuries and possibly infections.

Type Initials

Draw Initials

Type your initials:

2) I hereby RELEASE AND DISCHARGE PA Skydive Center, Inc dba Above the Poconos Skydivers, pilots, instructors, coaches, helpers, owners of the aircraft, owners of land utilized for parachuting activities, United States Parachute Association and owners, manufacturers, distributors and dealers of skydive equipment. Hereinafter collectively referred to as the “Released Parties,” from any and all liability, claims, demands or causes of action that I may hereafter have for infections, injuries and damages arising from my participation in parachuting activities, INCLUDING BUT NOT LIMITED TO, LOSSES CAUSED BY THE NEGLIGENCE OF THE RELEASED PARTIES.

Type Initials

Draw Initials

Type your initials:

3) I further agree that I WILL NOT SUE OR MAKE A CLAIM against the Released Parties for damages or other losses sustained as a result of my participation in parachuting activities. I also agree to INDEMNIFY AND HOLD THE RELEASED PARTIES HARMLESS from all claims, judgments and costs, including attorney’s fees, incurred in connection with any action brought as a result of my participation in parachuting activities.

Type Initials

Draw Initials

Type your initials:

4) I understand and acknowledge that parachuting activities have inherent danger that no amount of care, caution, instruction or expertise can eliminate, and I EXPRESSLY AND VOLUNTARILY ASSUME ALL RISK OF DEATH OR PERSONAL INJURY OR INFECTION SUSTAINED WHILE PARTICIPATING IN PARACHUTING ACTIVITIES WHETHER OR NOT CAUSED BY THE NEGLIGENCE OF THE RELEASED PARTIES.

Type Initials

Draw Initials

Type your initials:

5) I have been advised and recognize that parachuting activities are not covered by any personal accident or general liability insurance policy issued to the Released Parties.

Type Initials

Draw Initials

Type your initials:

6) SEVERABILITY / MULTIPLE WAIVERS: I agree that should one or more provisions in this Agreement be judicially determined to be unenforceable, the remaining provisions shall continue to be binding and enforceable against me. If I have executed any other agreement containing provisions relating to the release from liability and/or covenant not to sue in connection with the activities covered by this Agreement, I agree that the agreement which provides the most protection from liability and/or suit to PA Skydive Center, Inc. shall be enforceable against me by PA Skydive Center, Inc.

7) CONTINUATION OF OBLIGATIONS. I agree and acknowledge that the terms and conditions of the foregoing agreement shall continue in force and effect now and in the future at all times during which I participate, either directly or indirectly, in parachuting activities, and shall be binding upon my heirs, executors, administrators, personal representatives, and/or anyone else claiming on my behalf.

Type Initials

Draw Initials

Type your initials:

8) I agree to make sure the equipment I use is in-date and kept in accordance with the FAR's.

I Agree

Type Signature

Draw Signature

October 22, 2024

Please select who will be participating...

Adult Minor(s)
1 Minor 2 Minors 3 Minors 4 Minors 5 Minors More Minors 6 Minors 7 Minors 8 Minors 9 Minors 10 Minors

Continue

First Participant's Name

First Name*

Middle Name

Last Name*

Phone*

First Participant's Date of Birth*

First Participant's Information

Are you renting equipment and accepting the financial responsibility for any damages or loss to said equipment?*

Yes

IMAGE RELEASE. I give the Released Parties permission to use any images, taken of me by their staff or assignees, for promotional purposes without compensation of further permission. Write "NO" IF YOU DO NOT AGREE with the image release. LEAVE IT BLANK IF YOU APPROVE the image release.

First Participant's Signature*

Type Signature

Draw Signature

Second Participant's Name

First Name*

Middle Name

Last Name*

Second Participant's Date of Birth*

Second Participant's Information

Are you renting equipment and accepting the financial responsibility for any damages or loss to said equipment?*

Yes

Third Participant's Name

First Name*

Middle Name

Last Name*

Third Participant's Date of Birth*

Third Participant's Information

Are you renting equipment and accepting the financial responsibility for any damages or loss to said equipment?*

Yes

Fourth Participant's Name

First Name*

Middle Name

Last Name*

Fourth Participant's Date of Birth*

Fourth Participant's Information

Are you renting equipment and accepting the financial responsibility for any damages or loss to said equipment?*

Yes

Fifth Participant's Name

First Name*

Middle Name

Last Name*

Fifth Participant's Date of Birth*

Fifth Participant's Information

Are you renting equipment and accepting the financial responsibility for any damages or loss to said equipment?*

Yes

Sixth Participant's Name

First Name*

Middle Name

Last Name*

Sixth Participant's Date of Birth*

Sixth Participant's Information

Are you renting equipment and accepting the financial responsibility for any damages or loss to said equipment?*

Yes

Seventh Participant's Name

First Name*

Middle Name

Last Name*

Seventh Participant's Date of Birth*

Seventh Participant's Information

Are you renting equipment and accepting the financial responsibility for any damages or loss to said equipment?*

Yes

Eighth Participant's Name

First Name*

Middle Name

Last Name*

Eighth Participant's Date of Birth*

Eighth Participant's Information

Are you renting equipment and accepting the financial responsibility for any damages or loss to said equipment?*

Yes

Ninth Participant's Name

First Name*

Middle Name

Last Name*

Ninth Participant's Date of Birth*

Ninth Participant's Information

Are you renting equipment and accepting the financial responsibility for any damages or loss to said equipment?*

Yes

Tenth Participant's Name

First Name*

Middle Name

Last Name*

Tenth Participant's Date of Birth*

Tenth Participant's Information

Are you renting equipment and accepting the financial responsibility for any damages or loss to said equipment?*

Yes

Parent or Guardian's Email Address

Email*

Confirm Email*

Check to receive information, news, and discounts by e-mail.

Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*

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

Are you renting equipment and accepting the financial responsibility for any damages or loss to said equipment?*

Yes

Parent or Guardian's Signature*

Type Signature

Draw Signature