Thank you for your interest in skydiving with us! Please complete this form to provide us with the necessary information to ensure your safety and enjoyment.
First Name
Last Name
Date of Birth
Email Address
Phone Number
Street Address
City/Suburb
State/Province
Postal/Zip Code
Emergency Contact Name
Emergency Contact Phone Number
Have you ever skydived before?
If yes, how many jumps have you made?
What type of skydiving experience are you interested in?
Tandem Skydive (First jump experience with a certified instructor)
Accelerated Freefall (AFF) Course (Learn to skydive solo)
Static Line Jump (Parachute opens automatically)
Experienced Skydiver (Licensed skydiver with own equipment)
Other:
Please provide license number and issuing authority
Preferred Date(s)
First Choice
Second Choice
Preferred Time(s)
First Choice
First Choice
Weight
Height
Please answer the following questions honestly and to the best of your ability. This information is confidential and will be used to assess your suitability for skydiving.
Do you have any of the following conditions?
Heart conditions (e.g., heart attack, angina, bypass surgery)
Lung conditions (e.g., asthma, emphysema, collapsed lung)
Neurological conditions (e.g., epilepsy, seizures, head injuries)
Back, neck, or spinal injuries
Bone, joint, or muscle problems (e.g., fractures, dislocations, arthritis)
High or low blood pressure
Diabetes
Pregnancy
Recent surgery (within the last 6 months)
Eye conditions (e.g., glaucoma, detached retina)
Mental health conditions
Any other medical condition that may affect your ability to skydive? (Please specify)
Are you currently taking any medications?
If yes, please list them.
Have you ever been advised against participating in activities involving heights or rapid changes in pressure?
Do you consume alcohol or drugs?
If yes, please provide details.
I declare that the information provided in this form is true and accurate to the best of my knowledge. I understand that 1 skydiving is an inherently risky activity and that I am responsible for understanding and accepting these risks. I will carefully read and sign the waiver and release of liability before participating in any skydiving activities.
I understand that the final decision regarding my suitability for skydiving rests with the certified instructors and staff of [Skydiving Company Name]. They reserve the right to refuse service to anyone deemed unfit for participation.
Please feel free to ask any questions you may have about skydiving or our services.
Inquiry Template Insight
Please remove Inquiry Template Instructions before publishing this form.
This skydiving inquiry form is designed to gather essential information from potential customers before they book a skydive. It serves several key purposes:
In short, this inquiry form is a crucial first step in the process of booking a skydive. It balances the need for gathering essential information for safety and logistical purposes with providing a user-friendly way for potential customers to express their interest and ask questions. It protects the skydiving center while also ensuring a positive experience for the customer.