FOR OFFICE USE ONLY EXPERIENCED JUMPER INFORMATION PVAS #: ______
FIRST NAME: ______LAST NAME: ______
Home Address: ______CITY: ______State/Provence: ______Post Code: ______Country: ______Home Ph#: ______Cell Ph#: ______(if international, please include country & city codes) (if international, please include country & city codes) E-Mail: ______Birthdate: ______Weight: ______Height: ______(Month / Day / Year) Driver's License # or Foreign Passport #: ______Occupation: ______
SKYDIVING MEMBERSHIP INFORMATION USPA #: ______Expiration Date: ______License #: ______If Temporary USPA issued... Date Issued: ______Expiration Date: ______or Foreign Membership #: ______Expiration Date: ______
EMERGENCY CONTACT INFORMATION Please list at least one person who can be contacted other than friends you are here jumping with (We provide this information to emergency medical personnel in case of an injury) 1. Name: ______Relationship: ______Home Ph#: ______Cell/Work Ph#: ______(if international, please include country & city codes) (if international, please include country & city codes) 2. Name: ______Relationship: ______Home Ph#: ______Cell/Work Ph#: ______(if international, please include country & city codes) (if international, please include country & city codes)
PERSONAL EMERGENCY INFORMATION Health Insurance Carrier: ______Policy #: ______Do you take any medications (please list): ______Are you allergic to any medications (please list): ______
PERSONAL SKYDIVING GEAR INFORMATION - FOR OFFICE USE ONLY
Reserve Repack Date: ______SQ1 Initials: ______
IMPORTANT LEGAL DOCUMENT
READ CAREFULLY
WAIVER OF LIABILITY, ASSUMPTION OF RISKS COVENANT NOT TO SUE, AND INDEMNITY AGREEMENT
WARNING!!!! By signing this document you are giving up valuable legal rights in the event you should be injured and you or your family attempt to sue someone for your injuries.
FURTHERMORE, there is no insurance coverage provided by the Released Parties for any injuries that may happen to you while parachuting, skydiving, riding in aircraft, or just being a bystander on the airport premises. This document is intended to waive and release your and your family’s right to make claims for your injuries or to collect upon any insurance benefits.
NOTICE!!!! There are a number of other parachuting operations where you may choose to go if you do not want to sign this WAIVER OF LIABILITY, ASSUMPTION OF RISKS, COVENANT NOT TO SUE, AND INDEMNITY AGREEMENT. Ask for the list if you do not want to sign this document and it will be furnished to you.
DO NOT SIGN THIS DOCUMENT until after you have seen the videotape "The Perris Valley Airport, Inc. Waiver Video" and you have had an opportunity to think about the consequences of signing this document and fully understand its importance and its binding effect upon you and your family and heirs.
IMPORTANT LEGAL DOCUMENT READ CAREFULLY
______Signature
______Print Name
______Date
July 2011
WAIVER OF LIABILITY, ASSUMPTION OF RISKS COVENANT NOT TO SUE, AND INDEMNITY AGREEMENT
In consideration for being permitted to utilize the facilities and equipment and personnel at the Perris Valley Airport and to engage in parachute jumping, ground instruction, flying in aircraft, and related activities (thereinafter referred to "Parachuting Activities"),
I, ______(Print Name), for myself, my heirs, my personal representatives, and/or assigns, HEREBY AGREE TO THE FOLLOWING:
1. I HEREBY FOREVER RELEASE AND DISCHARGE (______) INITIAL the Perris Valley Airport, Inc., the land owners of the Perris Valley Airport, Ben Conatser, Diane Conatser , Pat Conatser, Melanie Peschio, Conatser FamilyTrust, Perris Valley Aviation Services, Inc., Perris Valley Skydiving School, Inc., P.M. Leasing, Inc., Bombshelter Bar & Grill, the owners or operators of any aircraft or land used in any way for the Parachuting Activities, their independent contractors, their instructors, pilots, and jumpmasters, Square One Parachute Sales & Service, any and all concessionaires of the Perris Valley Airport, Inc., the United States Parachute Association, and each of their respective officers, directors, shareholders, partners, agents, and employees (hereinafter collectively the “Released Parties”) (______), INITIAL
FROM ANY AND ALL CLAIMS AND LIABILITY including but not limited to the negligence, whether active or passive, or breach of any other duty or obligation imposed by law, of any of the Released Parties, including those acting on their behalf, resulting in personal injury (including death), accidents, illnesses, and property or pecuniary loss arising from but not limited to, my participation in the Parachuting Activities, except where caused by gross negligence or willful or wanton misconduct of any of the Released Parties. (______). INITIAL
2. I intend for this Agreement to be binding upon me regardless of when I participate in the Parachuting Activities. By signing this Agreement I confirm, agree and accept that its terms are fully binding even for my participation in the Parachuting Activites subsequent to this date, even occurring years subsequent. I agree that whenever I engage in the Parachuting Activities, this Agreement is and will be fully applicable. (______). INITIAL
3. I intend for this Agreement to apply to any of my relatives, personal representatives, heirs, beneficiaries, and next of kin or assigns or any other person who might pursue any legal action or claim regarding my injuries on my behalf or for their injuries that are or might be derivative of mine. (______) INITIAL
2 July 2011 4. I further agree that I WILL NOT SUE OR MAKE A CLAIM against the Released Parties or any of them for damages or other losses sustained as a result of my participation in Parachuting Activities (______). INITIAL
5. I FURTHER AGREE TO INDEMNIFY AND HOLD THE RELEASED PARTIES HARMLESS from all claims, judgments and costs, including attorney's fees, incurred in connection with any claim or action brought by me or on my behalf or as a result or consequence of my participation in Parachuting Activities (______), including but not limited to losses INITIAL caused by the active or passive negligence of the Released Parties, including those acting on their behalf, or caused by hidden, latent, or obvious defects on the drop zone or in the equipment or aircraft used in the Parachuting Activities. I FULLY UNDERSTAND THAT THE INTENT OF THIS AGREEMENT IS TO RELEASE AND DISCHARGE AND HOLD HARMLESS THE RELEASED PARTIES FROM ANY DUTY OF CARE TO ME WHAT- SO-EVER IN SO FAR AS IT IS POSSIBLE TO DO SO UNDER THE LAWS OF THE STATE OF CALIFORNIA. (______) INITIAL
6. I understand and acknowledge that Parachuting Activities have inherent dangers that no amount of care, caution, instruction or expertise can eliminate and I EXPRESSLY AND VOLUNTARILY ASSUME ALL RISKS ASSOCIATED WITH PARACHUTING ACTIVITIES including the risk of passive or active negligence of the Released Parties, including those acting on their behalf, and of hidden, latent, or obvious defects on the drop zone or in the equipment or aircraft used. (______) INITIAL
7. I recognize and fully accept that Parachuting Activities are not covered by any personal accident or general liability or life insurance policy maintained by the Released Parties (______). INITIAL
8. I understand that because of the unavoidable and unpredictable dangers involved in the use of parachutes the Released Parties are making NO WARRANTY OF ANY KIND, WHETHER EXPRESS OR IMPLIED, CONCERNING ANY AND ALL EQUIPMENT, AIRCRAFT, DROP ZONE OR FACILITIES PROVIDED by the Released Parties, or by those acting on their behalf, and I further understand and accept that parachuting is a dangerous sport and that associated equipment, such as PARACHUTES, DO NOT ALWAYS WORK the way they are expected to. Furthermore, I understand that my stability and body position can drastically affect the operation of the parachute. I also understand and accept the dangers and risks associated with airborne or ground collisions between myself and other parachutists or equipment, which collisions may occur at any time during Parachuting Activites. (______) INITIAL
I understand that the parachutes provided by the Released Parties are provided without any warranty that they are fit to use for any purpose whatsoever, without the warranty of merchantability and in particular without any warranty that they are fit to use in descending from an aircraft. Furthermore, I understand that there is no warranty that the parachutes have been packed without a hidden defect in the packing I UNDERSTAND THAT I NEED NOT USE THE EQUIPMENT SUPPLIED BY A RELEASED PARTY, AND THAT I MAY USE MY OWN EQUIPMENT, IF IT IS APPROVED BY A CERTIFIED RIGGER. (______) INITIAL
3 July 2011 I also acknowledge that the approval for use of any equipment by a rigger is not a warranty that the equipment is suitable for any purpose. I understand these disclaimers and I accept them. (______) INITIAL
9. I understand that because of the nature of sport parachuting, it is impossible for an instructor to determine with any degree of certainty that I have been properly trained to participate in the sport or that I have fully grasped and comprehended any instruction if any has been presented to me. Furthermore, I accept that it is impossible for an instructor to predict how I will react under the high-speed conditions, potential malfunctions, emergencies and stress that are inherent in sport parachuting. For that reason, I understand that no warranty whatsoever has been provided to me as to the adequacy of any training provided by the Released Parties. (______) INITIAL
I warrant to the Released Parties that, based upon my own evaluation of the training I have received, I believe that I have been adequately trained and that I can safely perform a parachute jump and cope with the high speed conditions and stress of sport parachuting. (______) INITIAL
10. I saw the videotape and heard the soundtrack of "THE PERRIS VALLEY AIRPORT WAIVER VIDEO" (______) before initialing and signing this document. INITIAL
11. I specifically agree that I have inspected to the degree I deem appropriate, all the land, facilities and equipment of the Perris Valley Airport, Perris Valley Airport, Inc., Perris Valley Aviation Services, Inc., P. M. Leasing, Inc., and their concessionaires. I acknowledge that the drop zone (landing area) does contain such dangerous objects as trees, fences, powerlines, hills, streams, buildings, rocks, hidden holes, uneven terrain, clods of dirt, poisonous snakes, unpredictable wind conditions, and other natural and man made objects that can cause injury to me upon landing; furthermore, I understand that the drop zone is in the vicinity of an active runway and that if I land near a taxiing aircraft my parachute may be caught by the aircraft or I may be struck by the aircraft, and I assume the risk of injury or death upon landing, and I understand that even under the best conditions, landing is an extremely dangerous activity and many injuries occur. Based upon my independent evaluation of all the risks I FURTHER AFFIRM MY ASSUMPTION OF THESE EXTREME RISKS AND THE OTHERS SET FORTH IN THIS AGREEMENT (______) INITIAL
12. As part of the consideration for my being allowed to utilize the facilities of the Perris Valley Airport and engage in Parachuting Activities, I PROMISE NOT TO SUE any of the Released Parties (______) for any cause of action whatsoever; INITIAL furthermore, I realize that the damages to the Released Parties for any breach of this promise are uncertain and difficult to establish and that in the event I breach this promise I agree that the LIQUIDATED DAMAGES THAT I WILL BE LIABLE TO PAY TO EACH OF THE RELEASED PARTIES NAMED IN ANY LAWSUIT I MAY BRING IS $25,000.00 (______) FOR EACH DEFENDANT. INITIAL
I further agree that this provision for liquidated damages shall apply to any action in which I am required to indemnify the Released Parties and it shall be in addition to any award made to the third party in each suit. (______) INITIAL
4 July 2011 13. I certify that I have been given a copy and have read the case of ANTHONY HULSEY v. ELSINORE PARACHUTE CENTER. (______) INITIAL
14. I certify that, considering my life style and the manner in which I am supporting my dependents, I have made adequate provisions for my spouse, if any, my children, if any, my heirs, if any , and all other persons dependent upon me so that in the event of my death they will be adequately provided for. (______) INITIAL
15. I hereby consent to the use of all visual documentation of my skydive produced by PVSS, Inc. for promotional usage by Released Parties. (______) INITIAL
16. It is further specifically agreed that venue and jurisdiction for any legal action arising out of any matter which is the subject of this document shall be in the Superior Court of the State of California, County of Riverside. (______) INITIAL
17. If any Court should decide that any clause in this Agreement is illegal or unenforceable, I agree that such determination shall not affect the validity or enforceability of the remaining provisions hereof. I expressly agree that this Agreement is intended to be as broad and inclusive as is permitted by the law of the State of California and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. (______) INITIAL
18. I certify and warrant that I am not currently under treatment for any of the following medical conditions:
1. Cardiac or pulmonary condition or disease 2. High or low blood pressure 3. Fainting spells or convulsions 4. Hearing loss or impairment 5. Nervous disorders 6. Diabetes 7. Kidney or related diseases 8. Shortness of breath 9. Psychiatric disorders 10.Subluxation or joint dislocation
I further certify and warrant that I am not on any regular medication and have not taken any alcoholic beverages or drugs within the last eight (8) hours. I also recognize that it is against Federal, State, United States Parachute Association and Parachute Center rules and regulations to take either alcohol or drugs while engaging in parachuting activities and agree to refrain from doing so. (______) INITIAL
19. I further certify and warrant that I am not relying on any oral or written representation or statements made by any of the Released Parties other than what is set forth in this documented Agreement. I further agree that this Agreement shall be governed by and interpreted in accordance with the laws of the State of California. (______) INITIAL
5 July 2011 20. I hereby declare that I am at least eighteen (18) years of age and am competent to sign this Agreement or, if not, that my parent or legal guardian shall sign on my behalf, and that my parent or legal guardian is in complete understanding and concurrence with this Agreement. (______) INITIAL
I CERTIFY THAT I HAVE CAREFULLY READ THIS ENTIRE AGREEMENT. I FULLY UNDERSTAND IT IS A BINDING CONTRACT AND ACCEPT THAT BY SIGNING THIS DOCUMENT I GIVE UP IMPORTANT LEGAL RIGHTS. IT IS MY INTENTION TO DO SO AND I DO SO VOLUNTARILY. I FULLY ACCEPT ITS CONTENTS AND SIGN IT OF MY OWN FREE WILL.
DATED______SIGNATURE______
PRINT NAME ______
ADDRESS ______
WITNESS ______
6 July 2011 LOADING & SAFETY
ON THE 5 MINUTE CALL
*Be completely geared up and be IN the loading area.
*Have all of your dirt dives and door jams done when the airplane pulls in.
*Perform your gear checks before boarding, and look at other jumpers’ equipment, handles, chest straps, pilot chutes, etc.
*Before loading the airplane, know the current wind direction and landing pattern, realizing this could change by the time you are landing.
*Review the manifest sheet and know your loading order before the plane arrives.
*Know the upper winds, anticipate and watch for timing between groups before exiting after the group or individual in front of you.
* Prepare to load by lining up at the gate as the plane is taxing into the loading area.
LOADING
*Load the plane immediately and ALWAYS approach the plane from behind the tail, no exceptions.
*Sit down and buckle up as quickly as possible.
*Load every plane from the front as if it’s full. Only after it is confirmed to be a lighter load should you then spread out evenly prior to the take off roll.
*Wearing your helmet is mandatory on take off. Camera flyers that don’t wear the helmet on take off must strap it down.
*Seat belts must be tight and secure prior to the take off roll. Do not take off your seat belt until 1000’.
*Aircraft jump door must be closed for take off until 1500’.
*After 1,500ft, whenever the jump door is open, seat belts must be off.
The plane will not wait. If you are not ready to load when the plane pulls in, the plane will leave.
SINGLE PASSES
For many reasons doing a single pass is both safer and more efficient. With the amount of open space we have at Perris we ask that we all strive towards getting everyone out on a single pass on every load. For both safety and efficiency please follow this plan:
*Know the winds aloft, if it is not posted in the loading area, ask the pilot, when it is safe to do so and share the information.
*Know the time you should allow between groups exiting and verify by looking out for appropriate separation.
*Know and anticipate the planned exit spot for the first group out.
*Open the door on the red light and check for other aircraft and high canopies.
*Get out IMMEDIATELY on the green light if there is no traffic and you feel it is safe to do so.
*On light wind days the first and last groups out are likely to be climbing out as far as Ethanac Rd. to the South or past Case Rd. to the north… Don’t be surprised.
*Continue exiting until the pilot turns on the red light.
*If you are open by 2,500 feet you will be landing well within the triangle. The retrieval vehicles will be there to help as needed.
*If you cannot properly enter the pattern and easily make it to the grass LAND SAFELY SOMEWHERE ELSE.
CANOPY FLIGHT AND LANDING PATTERN POLICY
* As soon as possible after opening look for other canopies, release your breaks and do a canopy control check.
*Fly your canopy perpendicular to jump run until you see the next group open safely.
*Determine where you will be landing. Recognize the established pattern and wind direction.
*Never cross the runway below 1000 feet.
*Do not struggle to make it to the grass and then enter the pattern too low. You should be entering the pattern by1000 feet.
*Whenever possible, fly upwind of your chosen landing zone and enter the downwind leg.
*If a Ground Safety Officer (GSO) is in the grass landing area, the landing direction for the grass and rectangular landing areas will be set by the tetrahedron or ground markers. If a GSO is not present, the landing direction will be established by the first person landing.
*The landing direction in the grass and rectangular landing areas, or within 100 feet of the grass and rectangular landing areas, will be either North or South. That is parallel to the runway, NO EXCEPTIONS OTHER THAN TANDEMS.
*If you are the first person landing, when there is no GSO, you will be setting the landing direction. When the winds are light and variable the landing direction should be set from South to North. A wind strong enough to warrant landing from North to South is one that is clearly displayed when ALL of the flag wind indicators that are blowing are favoring a South landing direction.
*Everyone landing in the grass, rectangular landing areas or within 100 feet of these areas will follow the established direction even if it is down wind or cross wind.
*IF YOU DO NOT LIKE THE LANDING DIRECTION THAT HAS BEEN SET LAND AT LEAST 100’ OUTSIDE OF THE GRASS AND RECTANGULAR LANDING AREAS.
*If the flags are flying in opposite directions it is possibly a dust devil and you should avoid the area.
*Landing patterns will ALWAYS be from over the triangle on the East side. Do a right hand pattern when landing to the North and a left hand pattern when landing to the South.
*If people are landing in opposite directions in the grass and rectangular landing areas you should consider those areas closed.
*No more than 90 degree turns are permitted below 1000 feet anywhere on the dz except for hop n pop’s into the high performance area located at the pond.
*There may be more than one plane dropping at any time doing offset or parallel jump runs. Look for jumpers entering the pattern from planes other than the one you just exited from.
*Individuals performing maneuvers in the pattern that cause other people to take evasive action will be grounded.
*Maneuvers that should not be done while entering or flying within the landing pattern include: -Spiraling -Sashaying -Flying in deep breaks -Turns greater than 90 degree’s
*Fly your canopy all the way to landing and maintain awareness through the collapsing of the canopy. No “Kiting” of your canopy.
*After landing look for incoming canopies, move to the side and clear the landing area as soon as it is safe to do so.
*Do not land west of the flag line.
*Stop at the flag line to check for aircraft landing or taking off. If a plane is on final approach or on the runway preparing to take off you must wait at the flag line until it passes.
*All the same rules apply when landing in the North field.
***TANDEMS AND STUDENTS HAVE RIGHT OF WAY***
STAY CLEAR OF TANDEMS AND STUDENTS AT ALL TIMES!!!!
YOU MUST STAY OUT OF THE GRASS OR RECTANGLE LANDING AREAS WHEN TANDEMS ARE LANDING!!!!!
SIREN—MOVE BACK from the runway all the way to the flag line immediately. All aircraft once on the runway or on final have the right away.
Your skydive is not over until you are back safely in the packing area…PLEASE BE SAFE!
Date ______
Name ______
Signature ______
Witness ______
KEY SAFETY POINTS FOR POSTING
GET A GEAR CHECK BEFORE BOARDING
REVIEW YOUR MALFUNCTION PROCEDURES REGULARLY
LOOK FOR OTHER CANOPIES AS SOON AS YOU ARE OPEN AND CONTINUE LOOKING UNTIL YOU ARE BACK IN THE PACKING AREA
NO TURNS MORE THAN 90 DEGREES BELOW 1000’
TANDEMS AND STUDENTS HAVE RIGHT OF WAY. STAY CLEAR OF TANDEMS IN THE PATTERN AND ON LANDING
WHEN TANDEMS ARE LANDING… THE GRASS IS CLOSED
LOOK IN EVERY DIRECTION BEFORE YOU MAKE A TURN