Confirmation of Informed Assumption of Risk

READ, UNDERSTAND, AND ACKNOWLEDGE

By signing this document, I agree to hold harmless Skydive Indianapolis and all associated companies and persons for any and all reasons. *

Please enter your name below (First Name & Last Name).

ⓘ Enter your first name & last name(s).

Date of Birth *

Your email. *

Please use an email you have access to.

ⓘ Enter a valid email.

I understand skydiving may result in serious injury or death. *

Please initial below (First initial, Last initial).

ⓘ Enter 2 letters (No spaces or punctuation).

I have read, understood and signed or digitally signed the waiver of legal rights. *

Please initial below (First initial Last initial).

ⓘ Enter 2 letters (No spaces or punctuation).

I understand that I may request a physical copy of the waiver of legal rights at any time. *

Please initial below (First initial Last initial).

ⓘ Enter 2 letters (No spaces or punctuation).

I have viewed and understood the video waiver. *

Please initial below (First initial Last initial).

ⓘ Enter 2 letters (No spaces or punctuation).

As per Title 14 of the Code of Federal Regulations (CFR) § 91.17 - Alcohol or drugs* and § 105.7 - Use of alcohol and drugs*. I acknowledge that Skydive Indianapolis reserves the right to refuse to allow me to make a skydive if I am intoxicated or appear to have consumed alcohol &/or drugs (which may pose a safety risk) within 8 hours prior to attempting to make a skydive. *

Please initial below (First initial Last initial).

ⓘ Enter 2 letters (No spaces or punctuation).

I understand that at any point I have the right to refuse to skydive, however, due to the high costs associated with skydiving, once the aircraft boarding process has been completed, all fees paid become non-refundable. *

Please initial below (First initial Last initial).

ⓘ Enter 2 letters (No spaces or punctuation).

Weight In Pounds (lbs) *

If unsure about weight in pounds (lbs) please ask staff member

ⓘ Weight in lbs (MAX 235lbs - You will be weighed).

Would you like to purchase video and/or photos of your skydive? *

Please select one.

ⓘ Please choose an option.

By filling out this form & clicking submit, I, hereby authorize "BUCKETLIST HOLDINGS LLC, D.B.A SKYDIVE INDIANAPOLIS" to take any photographs or videos (Content) of me or anyone who may be in my party as they deem appropriate and to use the Content for any purpose which may include, among others, advertising, promotion, marketing and packaging for any product or service. I agree that the Content may be combined with other images, text, graphics, film, audio, audio/visual works; and may be cropped, altered, or modified. I agree that I have no rights to the Content and that all rights to the Content belong to "BUCKETLIST HOLDINGS LLC, D.B.A SKYDIVE INDIANAPOLIS". *

Sign your name below.

ⓘ Enter your first name & last name(s).