Passenger Waiver Form

Passenger Waiver Form
Passenger name
First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Departure date and time
MonthDayYear
Date
Hour MinutesAM/PM Option
Return date and time
MonthDayYear
Date
Hour MinutesAM/PM Option
Departure location
Street Address
Street Address Line 2
CityState / Province
Postal / Zip CodeCountry
Destination location
Street Address
Street Address Line 2
CityState / Province
Postal / Zip CodeCountry
- I have decided, of my own free will, to participate in a flight in an aircraft owned or managed or operated by the company.
- I understand that the flight will be not be conducted under the rules found in Part 135 or Part 121 of the Federal Aviation Regulations applicable to airlines and air taxi operators, and that the flight will not comply with the enhanced safety requirements found in those Parts. I also understand that the aircraft I will fly in may be an older aircraft that does not necessarily have safety features found in more modern aircraft, and that pilot is someone I have chosen to fly with who does not meet the qualifications for a commercial pilot.
- I am aware that such activities include the risk of injury and even death, and I hereby elect to voluntarily participate in said activities, knowing that the activities may be hazardous to my property and to me. I understand that the company does not require me to participate in this activity. I voluntarily assume full responsibility for any risks of loss, property damage, or personal injury, including death that may be sustained by me, or any loss or damage to property owned by me, as a result of being engaged in such activities, whether caused by the releases or otherwise, to the fullest extent allowed by the law.
- By signing this form, I acknowledge and present that I have read the Waiver of Liability and Hold Harmless Agreement understand and sign it voluntarily as my own free act and deed; no oral representations, statements, or inducements, apart from this form, have been made.
- I, {passengerName}, am at least eighteen (18) years of age and fully competent; and I execute this form for full, adequate and complete consideration fully intending to be bound by the same.
Signature
Clear
Should be Empty: