Release, Waiver, and Assumption of Risk Agreement

Release, Waiver, and Assumption of Risk Agreement Executed by Passenger of Private Airplane

This Release, Waiver of Liability, and Assumption of Risk Agreement is given this the by the undersigned Passenger in favour of the Pilot and Owner of the Airplane on which Passenger is being given permission to travel in on this the

In consideration of being allowed to be a Passenger in a (describe type of Aircraft) , hereinafter called the Aircraft, the undersigned Passenger for myself, my personal representatives, heirs, executors, next of kin, spouses, minor children and assigns, do agree as follows:

1. The following definitions apply to the terms of this Agreement:

A. I, my and me means the undersigned and all for whom the undersigned might assert a claim, including, without limitation, any parent, spouse, child, legal representatives, heir and/or devisee or my estate.

B. Owner means

C. Passenger means

D. Pilot means

E. Flight Activities means all activities involving Passenger in any manner and of any nature whatsoever that occur with respect to Pilot’s use of Aircraft while I aboard including, but not limited to, take-offs and landings in the Aircraft in which I am a passenger, while said Aircraft is moving on the ground, and while it is parked on the ground, and whether one or more of its engines are on or off, and whether I am in the Aircraft or outside of it, and whether I am entering it or exiting it. Flight Activities further include all activities in which I am engaged from the time I arrive at the airport where the Aircraft is parked until the time I leave the airport, regardless of the time or location of those activities.

F. Released Parties means the Pilot and the Owner together with its officers, directors, shareholders, agents, employees, servants, pilots, maintenance technicians, ground personnel and attorneys, all together and each separately.

2. I do hereby release and discharge the Released Parties, insofar as it is possible to do so under the applicable law, from any duty of care whatsoever toward me during Flight Activities during the anticipated flight by me on the Aircraft the . This release and discharge from the duty of care includes a release from liability for any and all injuries caused to me and all damage to my property even if I do not or cannot foresee or anticipate them at this time and even if the Released Parties can reasonably foresee them. This release from liability and discharge from duty is intended to be as full and complete a release from liability and discharge from any duty of care as it is possible to make under applicable law and is intended to be binding upon not only me, but also upon any other person who might otherwise be able to assert a claim in the event I am injured or killed.

3. I understand that use of an aircraft in flight involves travel in three dimensions and such activity is subject to mishaps, injury or possibly even death; therefore I again affirm my voluntary assumption of all of these risks and I participate in Flight Activities on said (dates or dates) of my own free will and I forever release and discharge, insofar as it is possible to do so under law, the Released Parties in this Agreement from any liability whatsoever to me. Without meaning to limit the generality of this provision but rather to indicate my understanding of it, I intend this release to be from all liability for my wrongful death, for every type of injury to me, for all manner of pain and suffering to which I am subjected, for all psychological distress, for all permanent or temporary, total or partial paralysis or other disability, for all loss of earnings, for all my medical expenses, and for all loss of my enjoyment of life, and for all that I suffer as a consequence of these losses.

WITNESS my signature on this .