Fill and Sign the Passenger Owner Form

Release by Passenger in Favor of Aircraft Pilot and/or Aircraft Owner This Release is executed on ________________ (date) by _____________________ of __________________________________________ (street address, city, county, state, zip code) , referred to herein as Releasor , and _____________________, of __________________________________________ (street address, city, county, state, zip code) , referred to herein as Releasee. In consideration of being permitted to ride as a passenger in the Aircraft owned and/or operated by Releasee , Releasor does hereby releases, waives and discharge Releasee for any and all loss or damage, and any claim or damages resulting from the same, on account of injury to Releasor's person or property, even injury resulting in death of the Releasor, whether caused by the negligence of Releasee or otherwise while the Releasor is a passenger with regard to the following described Flight: A. Dates of Proposed Flight Departure: _____________________ (date) Returning: _____________________ (date) B. Points to be included in Proposed Flight: From _________________________________________ To _________________________________________ C. Aircraft to be used Type __________________________________________ Seating capacity _________________________________ D. Number of persons to be Transported _______________ Releasor assumes full responsibility for the risk of bodily injury, death or property damage due to the negligence of Releasee or otherwise while in or upon said Flight and/or said Aircraft. Releasor has executed this release at __________________________________________ (designate place of execution) the day and year first above written. ________________________ RELEASOR (Insert Notary Acknowledgment – form may vary by state)