Lost Prairie 2024 Boogie Registration

Registration for the 2024 Lost Prairie Boogie is now available. To facilitate getting you in the air as fast as possible this year, when you pre-register you must complete the skydiving waiver below and pay the boogie fee. That way the only thing you need to do when you get here is to sign the bottom of the waiver and have your gear checked. Registration is currently $75.

First Name
Last Name

Address

City

State

Zip

Country

E-mail Address

Home Phone

Work Phone

Date of Birth (Month/Day/Year)

Sex
MaleFemale

Height (feet)
123456789101112

Height (inches)
01234567891011

Weight (lbs)

UPSA Number

USPA Expiration Date

USPA License Number (A/B/C/D)

Total number of jumps

Jumps in last 3 months

Time in sport (Months/Years)

In case of emergency the following information will be needed. Please leave documents such as insurance cards with a friend or keep them on your person where they can be found if necessary.

Name of primary person to notify


Phone number of primary person to notify


Name of alternate person to notify


Phone number of alternate person to notify


Medications


Allergies to Medications

I recognize that parachuting is a strenuous, athletic endeavor and that parachutists are subject to health risks not normally associated with other sports. I hereby certify that I do not suffer from physical or mental infirmities that could affect my ability to safely engage in parachuting and its related activities, and that I am not and have never been under treatment for the following conditions

1. High or low blood pressure

2. Fainting spells or convulsions

3. Cardiac conditions/diseases

4. Pulmonary conditions/diseases

5. Nervous disorders

6. Shortness of breath

7. Kidney or related diseases

8. Obesity

Parachuting under the influence of drugs or alcohol is prohibited by Federal Aviation Regulations and Meadow Peak Skydiving rules.
Meadow Peak Skydiving's staff are in no way qualified to offer opinions about medical conditions and how they could be affected by parachuting.

In connection with any injury I may sustain or illness or other medical conditions I may experience during my participation in parachuting and related activities at Meadow Peak Skydiving, Inc., I authorize any emergency first aid, medication, medical treatment, or surgery deemed necessary by the attending medical personnel if I am not able to act on my own behalf.
Initials :

Your current medical insurance company:


Policy number or SSN

IF YOU DO NOT HAVE MEDICAL INSURANCE PLEASE WRITE "NONE" IN THE TWO FIELDS ABOVE THEN READ AND SIGN THE FOLLOWING STATEMENT

No medical insurance statement - fill out if you DO NOT have insurance

I am not covered by medical insurance and I understand Meadow Peak Skydiving, Inc. and all related parties carry no liability insurance. In spite of warnings about the dangers of parachuting, I intend to engage in parachuting activities even though I am not insured. This is a conscious decision on my part and I expressly and voluntarily assume all risk and responsibility for injury or death sustained while participating in parachuting activities.

Type your name here to signify your acceptance of the above statement, you will be required to physically sign upon your arrival
Name

AGREEMENT AND RELEASE OF LIABILITY

1. In consideration for being permitted to utilize the facilities and equipment of Meadow Peak Skydiving, Inc. for the purpose of parachute jumping, ground instruction, flying, and other related activities, I (PRINT NAME) being of lawful age (18 or older) enter into the following agreements with Meadow Peak Skydiving, Inc.

2. Parties involved in the agreements

These agreements are between Meadow Peak Skydiving, LLC, including its instructors, parachute packers, pilots, ground crews, aircraft and land owners, Meadow Peak Skydiving, LLC, PWC Properties, Inc., Lost Prairie Airstrip, Inc., the United States Parachute Association, and manufacturers, distributors, and dealers of skydiving equipment, and all of their officers, employees, subcontractors, assistants, heirs, legal representation and assigns, hereinafter referred to as "released parties", and myself, to include my legal representatives, spouse and family members, heirs and assigns.

Initials :

3. Assumption of risk

Parachuting activities, including ground instruction, parachute jumping, flying and related activities are inherently dangerous, injuries requiring professional medical care are not uncommon, and serious injury or death can and as resulted from participation on parachuting activities. Not all of these risks can be foreseen or prepared for, or avoided, to the extent that even if I do everything as I was trained to do and all equipment functions properly, I can still be injured or killed.

Initials :

4. Do you understand that you can be seriously injured or killed from parachuting and its related activities?

YES Initials : -or-

NO Initials :

5. Nature of parachuting equipment and aircraft

I understand that parachutes and aircraft, and their related equipment, are designed, constructed, maintained and operated by fallible human beings. Specifically, I understand and agree that the implied warranties of merchantability and fitness for a particular purpose and all other beings. Specifically, I understand and agree that the implied warranties of merchantability and fitness for a particular purpose and all other warranties, express or implied, are excluded from this transaction and that all equipment is purchased, rented, borrowed, or used in any way "as is."

Initials :

6. Nature of participants in parachuting activities

I acknowledge that pilots, instructors, jump masters, radio operators, mechanics, my fellow parachuting, and all others involved with parachuting are fallible human beings, capable of making mistakes that could result in my injury, suffering or death.

Initials :

7. Voluntary nature of participation

I agree that parachuting is of little value to society and that I am not under any compulsion to ride in or jump from an airplane. My participation is only for personal satisfaction and is entirely voluntary.

Initials :

8. Release from liability, including negligence

I agree that the released parties are in no way responsible for my safety, and I release them from any liability for my safety whether or not my losses, injuries, suffering or death was caused by their negligence, including improper action or failure to act.

Initials :

9. Agreement not to sue

In consideration for being permitted to engage in parachuting activities by the released parties, I promise not to sue the released parties or make any claims against them for damages, injuries, suffering or death, even if these are wholly or partially a result of negligence by the released parties. I further instruct my heirs, spouse and family members, legal representatives, and assigns to abide by my agreements with the released parties, including my promise not to sue.

Initials :

10. Option to purchase a revised agreement

I am aware that my right to due process of law cannot be waived, and that the above promise is a contractual agreement in return to the opportunity to participate in parachuting activities. I have been offered the opportunity to purchase a revised document omitting only the Agreement no to sue, for a price of $300.

I have chosen to:

Purchase the revised documentNot purchase the revised document

Initials :

11. Agreement to indemnify and hold harmless

I agree to indemnify and hold harmless the released parties from all claims, judgements, and costs, including attorney's fees, incurred in connection with any actions brought as a result of my participation in parachuting activities.

Initials :

12. Acceptance of financial responsibility

I understand that the released parties have no personal accident insurance or general liability insurance. I agree that I am solely responsible for any expenses, medical or otherwise, that I may incur from participation in parachuting activities. I also agree that the released parties are in no way responsible to myself, my spouse and family, or my heirs for any hardship from loss of income or from expenses that may result from my injury or death. Furthermore, I agree to indemnify the released parties for any loss, liability, damage, or cost that they may suffer due to my presence in or upon their facilities and equipment. I also understand that Meadow Peak Skydiving, Inc. is not responsible for lost, stolen or damaged items.

Initials :

13. Media release

I agree that if my image appears on any film or videotape taken at Meadow Peak Skydiving, Inc., I am willing to allow Meadow Peak Skydiving, Inc. to use it for publicity, informational, or entertainment purposes at no charge. I also state my willingness to be named in such materials.

Initials :

14. Continuation of obligations

I agree that all of the terms of this document apply any time now and in the future that I am engaged in parachuting and related activities at Meadow Peak Skydiving, Inc.

Initials :

15. Venue, arbitration, enforceability, and ambiguities

I agree that any actions rising from my participation activities will be submitted to arbitration by an arbitration board chosen by the released parties and that I will abide by the decisions of this board. I further agree that jurisdiction for any legal action arising out matters that are the subject of this document will be in Flathead County, Montana. I also agree that any ambiguities in this document shall be construed in the favor of the released parties, and that if any one clause of the document is deemed invalid, the balance of the document will nonetheless continue in full force.

Initials :

16. Do you understand that by signing this document you are giving up important legal rights in exchange for the opportunity to participate in parachuting activities, and that this document can and will be used against you in a court of law, and that similar documents have been upheld in several states?

Yes I agree Initials :
No I don't agree Initials :

17. In spite of the above warning do you fully consent to all of the terms of this document and sign it with complete understanding and free will?

Yes I agree Initials :
No I don't agree Initials :

18. I certify that the participant asserted clear understanding of the nature and effect of this agreement and release of liability.

Yes I agree Initials :
No I don't agree Initials :