Registration and Waiver Form

Registration and Waiver Form

The 2016 ASI Cross-Country Camp

Name: ______

Telephone: ______

Email: ______

Mailing Address: ______

______

Fees:

Single Pilot: $330 Full Camp Fee OR  $50 Deposit ($300 balance due)

Additional Pilot: $200 Full Camp Fee OR  $50 Deposit ($150 balance due)

Please make all checks payable toAir Sailing, Inc. Includes six days classroom sessions, course materials and one year of Air Sailing membership. Current Air Sailing members may deduct $50 from fees. Full camp fee includes $50 registration fee, non-refundable for registrants who cancel later than two weeks prior to the event. Tows, aero-retrieves, oxygen, banquet, and other incidentalsare not included.

Glider Registration #: N______Make & Model: ______

Glider Owner: ______Annual Inspection Date: ______

Liability Insurance Carrier and Policy #: ______

Note: Bring or mail two copies of your insurance summary of coverage page to camp. We will need to attach one to your Air Sailing Waiver of Liability and you will need to carry one in your glider. See the next page for our insurance requirements.

Pilot Certificate #:______Flight Review Date: ______

Your Ratings: Private CommercialCFIG Power Category

Club/Gliderport Affiliation: ______

Experience: Total Hours ______Solo Glider Hours______Glider Flights ______

Cross-Country Flights: ______Landouts ______

Bronze BadgeSilver Altitude Silver Distance Silver/Gold Duration
Gold Distance Diamond Goal Diamond Distance

Current ASI member:  Yes /  No Have Air Sailing Field Checkout:  Yes /  No

Signature: ______

Make check payable to Air Sailing, Inc. and mail with Registration Form to:

David Prather, 2016 Camp Manager

3179 Boeing Road

Cameron Park, CA 95682

/ (530) 748-7275Cell

TO:Pilots and Aircraft Owners operating at the Air Sailing Gliderport

FROM:Air Sailing, Inc. Board of Trustees

DATE:07-FEB-15

RE:Insurance Requirements for Aircraft Operating at Air Sailing Gliderport

All pilots and all owners of aircraft operating at the Air Sailing Gliderport

continue to be required to provide proof of acceptable aircraft insurance.

Acceptable aircraft insurance is current and valid owned-aircraft insurance and/or

current and valid non-owned aircraft insurance with coverage in the amounts of

$100,000 minimum per person or per passenger bodily injury liability, $1 Million

minimum property damage liability, and $1 Million minimum each accident or

occurrence, or otherwise mutually acceptable aircraft insurance. Proof of acceptable

aircraft insurance is an original or copy of the policy coverage summary page and

pilot(s) endorsement(s) showing the named insured(s) or an original or copy of a

certificate of insurance showing the named insured(s), or otherwise mutually

acceptable proof of insurance, in the pilot’s physical possession or readily accessible

in the aircraft and attached to the pilot’s ASI Waiver of Liability.

Obviously, Air Sailing must provide an exemption from this requirement for land

outs and other transient pilots and aircraft, but these pilots and owners should be

made aware of the requirement for future reference.

For questions or comments regarding these insurance requirements please contact

David Volkmann at or 775-787-3197.

Waiver and Assumption of Liability

Please enter me as a Participant in the 30thAnnual Air Sailing Cross-Country Camp (Camp, hereafter) to be held on or about June 12 through June17, 2016 at the Air Sailing Gliderport in Washoe County, Nevada. In consideration of acceptance of this entry, I hereby agree to be legally bound, for myself, my heirs, executors, administrators, representatives, successors or assigns and agree to waive any and all rights and claim for damages which I may have against Air Sailing, Inc., the Trustees of Air Sailing, Inc., the Camp Manager(s), or Camp Lead Pilots, or their agents, representatives, successors or assigns for any and all injuries or death suffered by me or by any member of my crew during the Camp. I further agree to assume full responsibility for and to hold the aforementioned entity and persons free and harmless from any and all obligations for damages to persons or property done by my crew or me.

I fully understand and agree that I am waiving any claims for damages for which I may suffer by virtue of any act of negligence arising in the future by any commission or omission of any of the aforementioned entity or persons or their agents, representatives, successors or assigns and that the consideration for this waiver is the permission of Air Sailing, Inc. allowing me to participate in said Camp and that such permission is being granted me in the reliance upon this waiver.

Participant ______Date ______

Signature ______

Location ______

Permission of Parent or Guardian for Participants less than 18 Years Old

I, the parent or guardian of the above-named pilot of less than eighteen years of age, do hereby join with said pilot in the above Waiver and Assumption of Liability and I do hereby certify that I have read and understand the above Waiver and Assumption of Liability; furthermore, I do hereby accept said waiver without reservation and I do hereby grant my permission to the above-named pilot to participate in the aforementioned Camp.

Parent or Guardian ______Date ______

Signature ______

Location ______

Emergency Contact Info / Field Contact Info

(Fill out once on field if you prefer)

In Case of Emergency:

Contact ______Relationship ______

Phone ______Alt Phone______

Address ______

______

Medical Factors:

Pertinent Aero-Medical issues you wish to communicate to camp staff or medical issues that may arise during a remote landout:

______

______

On-Field Info/Retrieve Info:

Staying overnight on field:  Yes /  No Location ______

Vehicle Description: ______License #: ______

Trailer Description: ______License #: ______

Does your trailer and retrieve vehicle have a checklist:  Yes /  No

Ball Hitch: 1 7/8” 2”  other

Electrical Connector: Flat 4 Round 4  other

Do you authorize any camp staff or participant to operate your vehicle/trailer to retrieve you:
 Yes /  No

Trailer/Vehicle Key Location: ______

Additional Instructions: ______

______