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Solo (non-tandem) Jumper Waiver


PA Skydive Center, Inc. dba Above the Poconos Skydivers  - PARACHUTE JUMPER AGREEMENT

This is an important legal document. Allow yourself sufficient time to carefully read and understand the entire document, You are welcome to seek your own legal counsel to explain it to you. Your initials indicates you understand and agree to all of the information and terms contained therein and by signing it, you are agreeing to give up certain legal rights.  


I have viewed and I warrant that I fully understand the accompanying “PA Skydive Center, Inc. - Parachute Jumper Agreement” video. 


MEDICAL STATEMENT

I represent and warrant that I have no known physical or mental infirmities or infections that would impair my ability to participate safely in skydiving for myself and others, or if I do have any such infirmities, they have been or are being successfully treated so they do not represent any foreseeable risk to myself or others. 


I hereby certify I am not taking any medications or substances, prescription, or otherwise, that would impair my ability to participate in skydiving. 


I also recognize it is against Federal, State, Skydiving Center, and U.S. Parachute Association rules and regulations to take either alcohol or drugs (any substance that impairs your ability to safely partake in skydiving) while engaging in parachuting activities and agree to refrain from doing so. I also certify I will allow sufficient time for the effects of alcohol and drugs/medication to be fully eliminated from my body prior to skydiving.


May 31, 2025

* 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.


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.


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.


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.


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.


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.


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

I Agree

May 31, 2025






First Participant's Name
First Name*
Middle Name
Last Name*
Phone*
First Participant's Date of Birth*
Date of Birth
First Participant's Information
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*
Second Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Second Participant's Information
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.
Third Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Third Participant's Information
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.
Fourth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Fourth Participant's Information
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.
Fifth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Fifth Participant's Information
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.
Sixth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Sixth Participant's Information
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.
Seventh Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Seventh Participant's Information
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.
Eighth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Eighth Participant's Information
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.
Ninth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Ninth Participant's Information
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.
Tenth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Tenth Participant's Information
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.
Parent or Guardian's Email Address
Email*
Confirm Email*
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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*
Date of Birth
Parent or Guardian's Information
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.
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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