Discovery Flight WAIVER & RELEASE OF LIABILITY AND MEDICAL STATEMENT (RFA-09-18) Name and Last Name: 1) VOLUNTARY PARTICIPATION: I, Voluntarily choose to participate in flying and / or flight training activities (“FLIGHT ACTIVITIES”) in an airplane operated by RIVERSIDE FLIGHT ACADEMY LLC (AIRPLANE). 2) ASSUMPTION OF RISK : I am aware that such FLIGHT ACTIVITIES can be hazardous and do involve certain risks and dangers that cannot be completely eliminated, including both those associated with (a) the piloting and operation of the AIRPLANE; and (b) the AIRPLANE itself. Specifically, I am aware that the FLIGHT ACTIVITIES have the potential to (a) impose physical stress upon and cause other physiological effects to occupants, including, in some cases, injury; and (b) result in a loss of control of the AIRPLANE and an accident. I am nevertheless, voluntarily participating in the FLIGHT ACTIVITIES with knowledge of the risks involved, at my own risk. I am competent to and assume these risks of my own free will. I ACCEPT ANY AND ALL RISKS OF DEATH, BODILY INJURY AND PROPERTY DAMAGE. PLEASE INITIAL 3) WAIVER AND RELEASE: As consideration for being permitted to participate in the FLIGHT ACTIVITIES, I agree that neither I nor my assignees, heirs, distributees, executors, guardians or legal representatives (“RELEASORS”) will make a claim or assert any causes of action (known or unknown) against, or sue RIVERSIDE FLIGHT ACADEMY LLC, its relates or affiliated entities or persons, directors, officers, employees, contractors or agents (“RELEASEES”) for death, bodily injury, property damage or any other liability, of any sort (“HARM”) arising from FLIGHT ACTIVITIES, including without limitation HARM that results from the active or passive negligence or other acts or omissions of RELEASEES. I hereby WAIVE and RELEASE RELEASEES from liability for, all such claims, causes of action and suits which RELEASORS or any of them now have or may hereafter have. This WAIVER and RELEASE includes, without limitation, HARM which results from (a) my being in the AIRPLANE, which could cause an accident; (d) negligent training, instruction or supervision of me, which could cause injury to me and / or a and accident; and (e) my slipping, falling or otherwise becoming injured on and about the AIRPLANE. 4) KNOWING AND VOLUNTARY EXECUTION:I HAVE CAREFULLY READ AND UNDERSTAND THIS WAIVER AND RELEASE, AND SIGN IT OF MY OWN FREE WILL. I AGREE THAT NO ORAL REPRESENTATIONS, STATEMENTS OR INDUCEMENTS APART FROM THE FOREGOING WRITTEN AGREEMENT HAVE BEEN MADE. I ALSO CERTIFY THAT I HAVE NO REASON TO BELIEVE THAT I HAVE ANY PHYSICAL OR MENTAL LIMITATIONS WHICH PREVENT ME FROM SAFELY PARTICIPATING IN THE FLIGHT ACTIVITIES. I CERTIFY THAT I AM OVER THE AGE OF 18, UNLESS MY PARENT LEGAL GUARDIAN HAS SIGNED BELOW. Signature:Date: Printed Name: Parent / Guardian Permission, Assumption of Risk, Waiver & Release I certify that I am the above child’s parent or legal guardian, As such, and individually, I have carefully read and understood this document in its entirety, and hereby (a) give the child permission to participate in the FLIGHT ACTIVITIES: (b) attest to the physical and medical certification in No.4 above; (c) expressly ASSUME ALL RISKS associated with the child’s participation in the FLIGHT ACTIVITIES; and (d) WAIVE and RELEASE all claims, causes of action and suits against RELEASES for HARM arising from the FLIGHT ACTIVITIES. Signature of Parent or Guardian:Date: Δ Prior to your first solo you will need a Renters Insurance Policy, here are 3 options unless you already have one. Stay in touch PHONE & EMAIL(951)588-6300info@riversideflightacademy.comLOCATION6651 Gemende Drive Suite BRiverside, CA 92504
