First Name
Last Name
Phone Number
Email Address
Date of Birth
Street Address
City/Suburb
State/Province
Postal/Zip Code
Emergency Contact Name
Emergency Contact Phone Number
Emergency Contact Relationship
Have you ever skydived before?
If yes, how many jumps have you completed?
Have you completed any formal skydiving training?
If yes, please specify.
Are you a licensed skydiver?
If yes, what license level do you hold?
A License
B License
C License
D License
Which skydiving course are you interested in?
Tandem Skydiving (Introductory jump with an instructor)
Accelerated Freefall (AFF) (Beginner course for solo skydiving)
Static Line Course (Beginner course with parachute deployment upon exit)
Advanced Skydiving Course (For licensed skydivers to refine skills)
Wingsuit Flying Course (For experienced skydivers)
Canopy Piloting Course (Focus on parachute control and landing)
Skydiving Instructor Course (For becoming a certified instructor)
Other:
What is your primary goal for taking this course?
Recreational skydiving
Competitive skydiving
Professional skydiving (e.g., instructor, videographer)
Personal achievement/challenge
Other:
Do you have any medical conditions that may affect your ability to skydive?
If yes, please specify.
Are you currently taking any medications?
If yes, please specify.
Do you have any injuries or physical limitations?
If yes, please specify.
What is your weight and height?
Weight (lbs/kg)
Height (ft/cm)
Are you pregnant?
Do you have any fears or concerns about skydiving?
If yes, please specify.
What is your preferred location for the course?
What is your availability for training?
Weekdays
Weekends
Flexible
How soon would you like to start the course?
Immediately
Within 1 month
Within 3 months
Not sure
Do you have your own skydiving equipment?
Will you require rental equipment?
How did you hear about us?
Do you have any questions or special requests?
I confirm that the information provided above is accurate to the best of my knowledge. I understand that skydiving involves inherent risks, and I am responsible for ensuring that I am physically and mentally fit to participate.
Signature
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