Parental Consent - Skydiving Lake Powell Arizona Utah

Parental Consent
Skydive Canyonlands is excited to now offer students 16 years
of age and older the chance to do a tandem skydive. We do need
a few more items of consent before we can take students under
18.
Before a student under age 18 can make a tandem skydive we will need the
following information:
Both biological/legal guardian parents must be present and sign the parental
consent tandem waiver. If both parents are not available one parent must be
present with a notarized statement of permission from the absent parent.
YOU NEED TO DOWNLOAD THE PARENTAL CONSENT
DOCUMENTS SO THAT THE ABSENT PARENT CAN SIGN THE
WAIVERS AND HAVE THEM NOTARIZED. If the absent parent is not
available for a statement, legal documents must be presented for the reason
why (i.e.; full legal and physical custody court documents/death certificate).
The tandem student will also need both a birth certificate and a picture id.
School ids are accepted as long as they are picture ids. The parents will
also need to bring picture id for relationship identification.
Weight limit for tandem students is 200lbs anybody over 200lbs will be a
charge of $2.00 a pound up to 250lbs and NO ONE under the age of 16
will be allowed to skydive.
We look forward to having the younger generation come to Skydive
Canyonlands and take part in a thrilling and exciting sport. Skydive
Canyonlands takes every precaution to protect the students and we will
make skydiving a most enjoyable and safe adventure.
Go Skydive Moab, LLC
AGREEMENT, RELEASE OF LIABILITY, AND ASSUMPTION OF RISK.
THE SPORT OF SKYDIVING COULD CAUSE SERIOUS INJURY
OR EVEN DEATH.
IN CONSIDERATION of being permitted to use the facilities and equipment of Go Skydive
Moab,LLC to engage in ground instruction, flying, parachute jumping, and related activities,
hereinafter collectively referred to as “parachuting activities”.
_
initials at each paragraph to indicate that I understand, HEREBY AGREE AS FOLLOWS:
1.
PARTIES INCLUDED.
I understand that this Agreement Release of Liability and
Assumption of Risk includes Go Skydive Moab,LLC, its agent, employees, instructors, jump
masters, pilots, the owners of the aircraft, mechanics and land utilized for “parachuting
activities”, the U.S. Parachute Association and its members, Canyonlands Field Airport, City
of Moab, Grand County and its employees or agents, Department of Airports, County of Grand
and its employees or agents, the Relative Workshop, Inc., Strong Enterprises, Jumpshack, Stunt
Adventures, and any manufacturers of equipment used, anyone working with Go Skydive
Moab,LLC, and anyone involved in my “parachuting activities”, hereinafter collectively
referred to in this Agreement, Release of Liability, and Assumption of Risk of “Go Skydive Moab,LLC”
(
2. RISKS CONTEMPLATED. This Agreement is made in contemplation of all “parachuting
activities, included but not limited to parachute jumping, ground instruction, flying and related
activities, the exist, free fall, time under canopy, the landing, and rescue operations or attempts by
“Go Skydive Moab,LLC” whether on, above, or off any facilities used by “Go Skydive Moab,LLC”.
(
) *Initial
(
) Parent Initial
3. RELEASE FROM LIABILITY. I hereby release “Go Skydive Moab,LLC” from any and all
liability, claims, demands, or action that I may have for injuries arising out of my participation in
“parachuting activities even if caused by negligence or other fault of “Go Skydive Moab,LLC”.
(
4. COVENANT NOT TO SUE.
I further agree that I WILL NOT SUE OR MAKE CLAIM
against “Go Skydive Moab,LLC.” for damages or other losses sustained as a result of my
participation in “parachuting activities or air plane rides” even if caused by negligence or
other fault of “Go Skydive Moab”.
5.
(
) *Initial
(
) Parent Initial
**I HAVE READ EACH PARAGRAPH CAREFULLY, MY INITIALS INDICATES I
UNDERSTAND & ACCEPT THE INFORMATION & TERMS CONTAINED THEREIN AND
SIGN IT OF MY OWN FREE WILL.
(
) *Initial
(
) Parent Initial
5. INDEMNIFICATION AND HOLD HARMLESS. I also agree to INDEMNITY AND HOLD
“Go Skydive Moab,LLC.” HARMLESS from all claims, judgments and costs, including but
not limited to attorney’s 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 understand 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 “Go Skydive Moab,LLC” including but not limited to equipment malfunction
from whatever cause, inadequate training, any deficiencies in the landing area, rescue
attempt, bad landings, or any other injury I may sustain even if caused by negligence or any
fault of “Go Skydive Moab,LLC.”.
6. ASSUMPTION OF RISK.
7.
(
) *Initial
(
) Parent Initial
7. PARTIES BOUND BY THIS AGREEMENT. It is my understanding and intention that this
Release and 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 Release is intended to
an does release “Go Skydive Moab,LLC.” from any and all claims or obligations
whatsoever arising in any way from my participation in “parachuting activities or air plane
rides” even if caused by negligence or other fault of “Go Skydive Moab,LLC.”
(
8. LIMITATION OF WARRANTY. “Go Skydive Moab,LLC.” hereby warrants that the
equipment provided by “Go Skydive Moab,LLC.” has been previously used for
“parachuting activities or air plane rides”.
(
) *Initial
(
) Parent
Initial This warranty is the only warranty made and is made in lieu of any other warranties,
express
or implied, including but not limited to warrant of merchant ability or fitness, for a particular
purpose. I have read the above paragraph acknowledge that I understand it and accept the
limitation of warranty.
(
) *Initial
(
) Parent
Initial
9. DURATION OF RELEASE. It is my understanding and intention that this Release and
Agreement be effective not only for my first jump or air plane rides but for any subsequent
jumps or air plane rides or activities in any way associated with “Go Skydive Moab,LLC”.
(
10. ENFORCEABILITY. I agree that if any portions of this Release and 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 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.
(
**I HAVE READ EACH PARAGRAPH CAREFULLY, MY INITIALS INDICATES I
UNDERSTAND & ACCEPT THE INFORMATION & TERMS CONTAINED
THEREIN AND SIGN IT OF MY OWN FREE WILL.
(
11. LEGAL RIGHTS.
It has been explained to me, and I understand, that by signing
this document I give up important legal rights. It is my intention to do so.
(
12. UNDERSTANDING/BINDING OF AGREEMENT. I hereby certify that I have read and
understand the contents of this document and accept all terms and conditions contained therein.
(
13. “GO Skydive Moab,LLC.” reserves the rights to use any video and/or still pictures that
you may appear in for use in advertisement and/or promotional material.
(
14. Representations and Warranties as to Medical Condition: I represent and warrant that
(a) I have no physical infirmity, except those listed below, am not under treatment for any
other physical infirmity or chronic ailment or injury of any nature, and have never been
treated for any other of the following: cardiac or pulmonary conditions or diseases,
diabetes, fainting spells or convulsions, nervous disorder, kidney or related diseases, high
or low blood pressure; (b) I am not under any medication of any kind at the present time
and (c) I do/do not (strike one) wear corrective lenses. If I am prescribed corrective lenses, I
agree
to
wear
them
during
my
intentional
parachute
jump.
(list infirmities, if not, state “none”)
DATE __________
PRINT YOUR NAME ________________________________
WITNESS SIGNATURE _________________________________
YOUR SIGNATURE _________________________________
* I HAVE READ EACH PARAGRAPH CAREFULLY MY INITIALS INDICATES I
UNDERSTAND & ACCEPT THE INFORMATION & TERMS CONTAINED THEREIN
AND SIGN IT OF MY OWN FREE WILL.
(________) * Initial
PARENTAL CONSENT
WE ______________________________
& _____________________________
PARENTS OF
Print Name
HAVE READ EACH PARAGRAPH CAREFULLY AND
UNDERSTAND & ACCEPT THE INFORMATION & TERMS CONTAINED THEREIN AND
GIVE OUR CONSENT TO OUR SON OR DAUGHTER TO MAKE A TAMDEM SKYDIVE AND
SIGN THIS CONSENT FORM OF OUR OWN FREE WILL.
Parents Signature _____________________________
& __________________________________
* I HAVE READ EACH PARAGRAPH CAREFULLY MY INITIALS INDICATES I
UNDERSTAND & ACCEPT THE INFORMATION & TERMS CONTAINED
THEREIN AND SIGN IT OF MY OWN FREE WILL.
(
)*Initial
GRAND
COUNTY
Lessee shall distribute to each individual who utilized the leased premises, a copy of the Government Code 831.7, which
set forth in pertinent part the following with respect to the non liability of Lesser for hazardous recreational activities:
*(A) Neither a public entity nor a public employee is liable to any person who participates in a hazardous recreational
activity, including any person who assist the participant, or to a spectator who knew or reasonably should have
known that the hazardous recreational activity created a substantial risk of injury to himself or herself and was a
voluntarily in the place of risk, or having the ability to do so failed to leave, for any damage or injury to property
or persons arising out of that hazardous recreational activity.
*(B) As used in this section, “hazardous recreational activity” means a recreational activity conducted on property of a
public entity which creates a substantial (as distinguished from minor, trivial, or insignificant) risk of injury to a
spectator. “Hazardous recreational activity” also means:
*(1) Water contact activities, except diving, in places where or at a time when a lifeguards are not provided
and reasonable warning thereof has been given or the injured party should reasonably have known that
there was no lifeguard provided at the time.
*(2) Any form of diving into the water from other than a diving board or diving platform or at a place or from
any structure where diving is prohibited and reasonable warning thereof has been given.
*(3) Animal riding, including equestrian competition, archery, bicycle racing or jumping, boating, cross-country
and downhill skiing, hang gliding, kayaking, motorized vehicle racing, off road motorcycling or four-wheel
driving of any kind, orienteering, pistol and rifle shooting, rope climbing, rocketeering, rodeo, spelunking,
skydiving, sport parachuting, body contact sport (i.e. sports in which it is reasonably foreseeable that there
will be rough bodily contact with one or more participants), surfing, trampoline, tree climbing, tree rope
swinging, water skiing, white water rafting, and wind surfing.
*(C)
Notwithstanding the provisions of subdivision (a), this section does not limit liability which would otherwise exist
for any of the following :
*(1) Failure of the public entity or employee to guard or warn of a known dangerous condition or of another
hazardous recreational activity known to the public entity or employee that is not reasonably assumed by the
participant as inherently a part of the hazardous recreational activity out of which the damage or injury arose.
*(2) Damage of injury suffered in any case where permission to participate in the hazardous recreational activity
was grated for a specific fee. For the purpose of the paragraph, “specific fee” does not include a fee or
consideration charged for a general purpose such as general park admission charge, a vehicle entry or parking
fee, or an administrative or group use application or permit fee, as distinguished from a specific fee charged
for participation in the specific hazardous recreational activity in the hazardous recreational activity out of
which the damage or injury arose.
*(3) Injury suffered to the extent proximately caused by the negligent failure of the public entity or public
employee to properly construct or maintain in good repair any structure, recreational equipment or
machinery, or substantial work of improvement utilized in the hazardous recreational activity out of which the
damage or injury arose.
*(4) Damage or injury suffered in any case where the public entity or employee recklessly or with gross
negligence promoted the participated in or observance literature or a public announcement or advertisement
which merely describes the available facilities and service on the property does not in itself constitute a
reckless or grossly negligent promotion.
*(5) An act of gross negligence by a public employee which is the proximate cause of the injury.
(Nothing in this subdivision creates a duty of care or basis of liability for personal injury for damage to personal property)
*(D)
Dated:
Nothing in this section shall limit the liability of an independent concessionaire, or any person or organization
other than the public entity to use the public property, for injuries or damages suffered in any case as a result of the
operation of a hazardous recreational activity on public property by the concessionaire, person or organization.
Signature ___________________________________________________________________
Parent Signature _____________________________________________________________
Parent Signature ______________________________________________________________
Witness ______________________________________________________________________
Go Skydive Moab,LLC
The Uninsured Relative Workshop, Inc. d/b/a Relative Workshop, Strong Enterprises, Inc.
& Eclipse Tandem system Stunts
Tandem Parachute System Jumper Agreement
*Please read each paragraph carefully. Your initial indicates you understand and agree to all
of the Information and terms contained therein.
This is an important legal document. Allow yourself sufficient time to carefully read and understand the entire document because by signing it you are
agreeing to give up certain legal rights.
(
) *Initial
(________) Parent Initial
In consideration of the Uninsured Relative Workshop Inc., doing business as Relative Workshop, and Strong Enterprises, Inc., Eclipse Tandem system stunts
hereinafter referred to as “Corporations”, allowing me the privilege of utilizing a dual-harness, dual container parachute pack assembly designed, manufactured
and/or assembled by the Corporations for the purpose of performing an intentional parachute jump, I agree that:
1)
Representations, Warranties & Assumptions of Risk: I understand that parachute jumping will expose me to the risk of personal injury, property damage and/or
death. I understand that the success of my jump is dependent upon the perfect functioning of the airplane from which I intend to jump and the parachute
system, and that neither the airplane nor the parachute system can be guaranteed to function perfectly. I 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/or failure to function, including those which may result from some defect in design,
assembly, and/or manufacture, as well as those risks arising from improper
and/or negligent operation and/or use of the equipment, for the thrill of
participating in this activity, understanding full well those risks may include personal injury, property damage, and/or death.
(________) *Initial
2) Exemption and Release from Liability: I exempt and release the following persons and organizations: (
) * Initial
(A) The Corporations and their officers, directors, agents, servants, employees, and other representative (________) *Initial
(________)Parent Initial
(
)Parent Initial
(________) Parent Initial
(B) Manufacturers, designers, and suppliers of component equipment incorporated in the dual-harness, dual-container parachute pack assembly to which I will be
attached during my intentional parachute jump;
(
) * Initial (
)Parent Initial
(C) Owners, suppliers and operators of aircraft from which I am to make my intentional parachute jump (
) * Initial
(
) Parent Initial
(D) The owner of the dual-harness, dual-container parachute pack assembly, and any of its components, to which I will be attached during my intentional parachute
jump;
(
) * Initial (
) Parent Initial
(E) The operator of the dual-harness, dual container, parachute pack assembly to which I will be attached during my intentional parachute jump;
(
) * Initial
(
) Parent Initial
(F) If I am making my intentional parachute jump at or near a parachuting/skydiving facility, the owners and operators of that facility, as well as their
Officer, directors, agents, servants, employees, shareholders, and other representatives;
(
)* Initial (
) Parent Initial
(G) The owners and lessees, if any, of land upon and from which the parachute jumping and related aircraft operations are conducted; and
(
) * Initial (
) Parent Initial
(H) Any other person and/or organization which is or may be liable for any loss or injury to me or my property, or my death, arising out of my participation in any of
the activities covered by this Agreement (as defined below);
(
) * Initial (
) Parent Initial
From any and all liability, claims, demands or actions or causes of action whatsoever arising out of any damage, loss or injury to me or my property, or my death,
whether occurring while I am training and/or preparing for my intentional parachute jump, while I am present in aircraft from which the jump is to be made, while I
am making my intentional parachute jump, or while I am engaged in related activities (hereinafter referred to a s “activities covered by this Agreement”), whether
such loss, damage, injury, or death results from the negligence and/or other fault, either active or passive, of any of the persons and/or organizations described in
paragraphs 2(A) – (H) above, or from any other cause
(
) * Initial (
) Parent Initial
3) Covenant Not to Sue: I agree never to institute any suit or action at law or otherwise against any of the organizations and/or persons described in
paragraph 2(A) through (H) above, or to initiate or assist in the prosecution of any claim for damages or cause of action which I may have by reason of injury to
my person or property,or my death, arising from the activities covered by this Agreement, whether caused by the negligence and/or fault, either active or passive,
of any of the organizations and/or persons described in paragraph 2(A) through (H) above, or from any other cause. I further expressly agree that I will never raise
any claim against any of the organizations and/or persons described in paragraph 2(A) through ( H) above for product liability, failure to warn, negligence, breach of
warranty, breach of contract, or strict liability, regardless of whether my claims for damages or injuries are alleged to result from the fault or negligence of the parties
released. I further agree that my heirs, executors, administrators, personal representatives, and/or anyone else claiming on my behalf, shall not institute any suit of
action at law or otherwise against any of the organizations and/or persons described in paragraph
2 (A) through (H) above, nor shall they initiate or assist the prosecution of any claim for damages of cause of action which I, my heirs, executors, administrators,
personal representatives, and/or anyone else claiming on my behalf may have by reason of injury to my person or property, or my death arises from the activities
covered by this Agreement, whether caused by the negligence and/or fault, either active or passive, of any of the organizations and/or persons described in
paragraph 2(A) through (H) above, or from any other cause, I hereby so instruct my heirs, executors, administrators, personal representatives, and/or anyone else
claiming on my behalf. Should any suit or action at law or otherwise be instituted in violation of this Agreement against any of the organizations and/or
persons described in paragraph 2(A) through (H) above, I agree that such organizations and/or persons shall be entitled to recover, in addition to any other
damages which may be incurred, reasonable attorneys’ fees and costs incurred in defense of such suit or action, including any appeals there from.
(
) * Initial (
) Parent Initial
I HAVE READ THE ABOVE PARAGRAPHS CAREFULLY. MY INITIALS INDICATE I UNDERSTAND & ACCEPT THE
INFORMATION & TERMS CONTAINED THEREIN AND SIGN IT AT MY OWN FREE WILL. (
) * Initial (
) Parent Initial
* Please read each paragraph carefully. Your initial indicates you understand and agree to all of the
information and terms contained therein.
4) Indemnity Against Claims: I will indemnify, save and hold harmless the organizations and/or persons described in paragraph 2(A) through (H) above 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 Agreement, whether resulting
from the negligence and/or other fault, either active or passive, or any of the organizations and/or persons described in paragraph 2(A) through (H) above, or
from any other cause.
(
) * Initial (
) Parent Initial
5) Validity of Waiver: 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 described in paragraph 2(A) through (H) above because of injury to my person or property, or my death, due to
the activities covered by this Agreement, this Agreement can and will be used in court, and that such agreements have been upheld in courts in similar
circumstances.
(
) * Initial (
) Parent Initial
6) Representations and Warranties as to Medical Condition: I represent and warrant that (a) I have no physical infirmity, except those listed below, am not under
treatment for any other physical infirmity or chronic ailment or injury of any nature, and have never been treated for any other of the following: cardiac or
pulmonary conditions or disease, diabetes, fainting spells or convulsions, nervous disorder, kidney or related diseases, high or low blood pressure; (b) I am not
under any medication of any kind at the present time; (c) If I am prescribed corrective lenses, I agree to wear them during my intentional parachute jump
List infirmities, if none, state “none”:
(
) * Initial (
) Parent Initial
7) Waiver of Jury Trial/Applicable Law/Venue/Headings: I agree that the law of the State of Florida shall apply to issues involving the construction, interpretation,
and validity of the Agreement, and that Florida law shall govern any dispute between the parties arising from the activities covered by this Agreement. In the
event this Agreement is violated and suit is brought against any of the organizations and/or persons described in paragraph 2(A) through (H) above, I waive
my rights to a jury trial, and agree that Volusia County, Florida shall be the sole venue for any suit or action arising from the activities covered by this Agreement.
I agree that the headings and sub-headings used throughout this Agreement are for convenience only and have no significance in the interpretation of the body of
this agreement.
(
) * Initial (
) Parent Initial
8) 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
exemption and/or 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 the Uninsured Relative Workshop Inc., d/b/a Relative Workshop and to Strong Enterprises, Inc.& Eclipse
Tandem system, stunts shall be enforceable against me by the Uninsured Relative Workshop, Inc. d/b/a Relative Workshop and Strong Enterprises, Inc.
Eclipse Tandem System Stunts.
(
) * Initial (
) Parent Initial
9) Continuation of Obligations: I agree and acknowledge that the terms and conditions of this Agreement shall continue in force and effect now and in the future
at all times during which I participate in the activities covered by this Agreement, and shall be binding upon my heirs, executors, administrators, personal
representatives, and/or anyone else claiming on my behalf. This Agreement supersedes and replaces any prior such agreement I have signed.
(
) * Initial (
) Parent Initial
10) Viewing of Video: I have viewed and I warrant that I fully understand the accompanying “Tandem Waiver” video.
(
) * Initial
(
) Parent Initial
I HAVE READ THE ABOVE PARAGRAPHS CAREFULLY. MY INITIALS INDICATE I UNDERSTAND & ACCEPT THE
INFORMATION & TERMS CONTAINED THEREIN AND SIGN IT AT MY OWN FREE WILL. (
) * Initial
TANDEM JUMPER:
Signature ____________________________________________________________________
Print Name ___________________________________________________________________
Witness ______________________________________________________________________
I freely and voluntarily agree to all of the above by signing this contract on the
day of ________________
at Go Skydive Moab,LLC .
PARENTAL CONSENT
WE
&
PARENTS OF
(Print Full Name)
HAVE READ THE ABOVE PARAGRAPHS CAREFULLY AND
(Print Name)
UNDERSTAND & ACCEPT THE INFORMATION, TERMS AND CONDITIONS CONTAINED THEREIN, AND GIVE OUR
CONSENT TO OUR SON OR DAUGHTER TO MAKE A TAMDEM SKYDIVE AND SIGN THIS CONSENT FORM OF OUR
OWN FREE WILL.
_______________________________________
& ____________________________________________
(Parents Signature)
I HAVE READ THE ABOVE PARAGRAPHS CAREFULLY. MY INITIALS INDICATE I UNDERSTAND & ACCEPT THE
INFORMATION & TERMS CONTAINED THEREIN AND SIGN IT AT MY OWN FREE WILL. (
) Parent Initial