2019 Nashville Pilot Camp Registration

Transcription

1 2019 Nashville Pilot Camp Registration Camp Information The following pages contain the registration form, code of conduct, and all medical paperwork to be filled out. Be sure to fill these out and mail, , or bring them in with the deposit as soon as possible to hold your child s place. All registrations will be processed on a first come, first served basis. (20 student seats are available). You may scan and this form to info@nashvilleflighttraining.com or mail to PO Box Nashville, TN REGISTRATION Total registration cost is $ In order to comply with TSA and FAA regulations, your child must be a United States Citizen and hold a birth certificate as issued by the United States. A copy of your birth certificate must be provided by June 1, 2019 via or mail. PAYMENT A $150 deposit is required to hold a camper s reservation. The tuition balance is due by June 1, In the event that you are not able to provide the balance by the due date, please contact us as soon as possible. Campers will receive a t-shirt, instruction book, and logbook at no additional charge on the first day of the camp. CANCELLATIONS/REFUNDS Request for cancellation must be received in writing. Deposits are non-refundable. Refunds will be given less the $150 deposit. No refunds can be given if the request for cancellation is received less than 14 days prior to camp date start. Please allow 2-4 weeks for refunds to be processed. CAMP STAFF The staff at Nashville Pilot Camp and Nashville Flight Training includes FAA certified flight instructors with many years of aviation and teaching experience. In addition, there will be both male and female staff on site to assist. One of the camp directors will be present at all times, as will the executive staff of Nashville Flight Training. We take our business and the care and safety of every child very seriously. ADDITIONAL INFORMATION Camp is conducted at Nashville Flight Training, 801 Hangar Lane, Nashville, TN. Check-in for camp begins Monday morning at 8:45 a.m. Campers must be picked up promptly at 12:00 p.m. Because our camp and school is located at Nashville International Airport and we are required to abide by strict security procedures, if your child is not picked up by 12:15 p.m., you will be charged at a rate of $5 per minute. For any additional information, please call One last thing - in the event that we have weather issues during camp and we are not able to fly, every effort will be made to reschedule accordingly. Checks can be made payable to Nashville Flight Training and sent to Nashville Flight Training - PO Box Nashville, TN

2 CAMPER INFORMATION (Please legibly print or type information below) First Name MI Last Name Home Mailing Address City State Zip School Date of Birth Grade (Fall 2018) Age Gender How did you hear about Nashville Pilot Camp? Height Weight (Weight is strictly for airplane calculations and will not be disclosed to other students). T-Shirt Size: S M L XL PARENT/GUARDIAN INFORMATION First Name MI Last Name Home Mailing Address City State Zip Daytime Phone Evening Phone Cell Phone Anyone authorized to pick up child from camp (ID Required) Payment If wishing to pay by check, make payable to Nashville Flight School LLC Check # Check Amt $ CC: Visa MC Discover AMEX CC Amt $ CC# Exp. Code on Back SIGNATURE: Nashville Pilot Camp Code Of Conduct

3 Camps are designed for the enjoyment and benefit for all campers involved. With this as the objective, we anticipate that no camper is here who does not want to be here. Should any disciplinary problems occur, we will contact the parent/guardian to come pick up the camper. Please read and sign the Nashville Pilot Camp code of conduct. 1. Nashville Pilot Camp is located at Nashville International Airport. With a perfect safety record, safety is a priority for our facility. Because safety is our #1 priority, our instructors reserve the right to operate at their discretion: including decisions to take off and land and address any variables including but not limited to weather, air traffic control, operational and mechanical concerns. For security measures, we reserve the right to refuse service to anyone at anytime for any reason. 2. While our instructors take great precautions to ensure your safety, it should be acknowledged that flying in airplanes is a risk. By boarding an airplane, you hereby indemnify and release Nashville Pilot Camp, Nashville Flight Training, Nashville Flight School LLC and all instructors from any and all damages, injuries, liabilities, costs, losses and expenses arising out of or connected with any claim, demand or action by a third party before, during and after said flight. 3. Please keep hands and feet to yourself. Respect other campers, instructors, employees and property. LISTEN and acknowledge instructions at all time. 4. Please do NOT bring any items of value to camp, or any of the following items: ipods, hand held video games, chewing gum, or any other distracting items. Cell phones must be kept away at all times of camp and may be used in emergencies and at break if necessary. In the event that a student s cell phone rings during training, it may be confiscated until the end of camp that day. Parents should call with any emergencies. 5. Physical aggression, continued disrespect, or continued disruption of camp activities with result in one or more of the following: Dispatch of the Nashville Airport Police, dispatch of the Transportation Safety Administration, and being sent home immediately. No refunds will be given to campers who are sent home and may not be eligible for future camps. For the safety of all campers, this rule stands firm. I have read and understand the Nashville Pilot Camp Code of Conduct and agree to its terms. Signature of Parent/Guardian Date Camper Signature Date

4 MEDICAL INFORMATION AND RELEASE Nashville Flight School LLC, dba Nashville Flight Training MINOR OR ADULT PARTICIPANT (please complete in blue or black ink) Name Last First MI Address Street City State Zip Date of Birth mm/dd/yyyy Health Insurance Carrier: Policy Number: Group Number: Personal Physician: Physician Address: Street City State Zip Physician Phone Number: PARENT, LEGAL GUARDIAN, OR OTHER PERSON WHO HAS LEGAL AUTHORITY TO AUTHORIZE MEDICAL TREATMENT TO PARTICIPANT IN CASE OF EMERGENCY, PLEASE CONTACT: Name: Relation: Address: Street City State Zip Phone: Home: Work: Cell: List any chronic or acute or any other relevant medical problems and explain: List any allergies to pollen, food or medicine: List any medications presently being taken:

5 I acknowledge that the participants immunizations are current: yes no I or my child or dependent plan to attend Nashville Flight School, LLC, Nashville Flight Training and Nashville Pilot Camp, hereinafter referred to as camp. In case of accident or illness, I give permission to receive medical treatment as deemed appropriate. I will assume responsibility for any medical billing. Adult Participant or Parent/Legal Guardian Signature Date Please Print Camper Participant s Name: If Minor, Please Print Parent s Name:

6 Minor s (under age 18) Name: Date of Birth: PARENT/LEGAL GUARDIANS RELEASE FOR MINOR PARTICIPATION By signing this document you are waiving certain legal rights. Read carefully before signing. Please complete in blue or back ink. GENERAL RELEASE AND INDEMNIFICATION AGREEMENT I hereby represent that I am the parent or legal guardian of Participant, who is under the age of 18. For and in consideration of Nashville Flight School, LLC, dba Nashville Flight Training permitting Participant to participate voluntarily in Nashville Pilot Camp to be held during 2018 at Nashville Flight School, LLC, dba Nashville Flight Training s facility in Nashville, Tennessee, hereafter referred to as camp, I hereby assume all risks associated with the camp, and I release Nashville Flight School, LLC, dba Nashville Flight Training, its trustees, employees, students, and agents from all claims, demands, suits, causes of action, or judgements which participant or I ever had, now have, or may have in the future or which our heirs, executors, administrators, or assigns may have, or claim to have against Nashville Flight School, LLC, dba Nashville Flight Training or its trustees, employees, students, and agents, arising out of or in any way connected to the camp, for all personal injuries, known or unknown, property damages, or claims for wrongful death, caused by the acts, omissions or negligence or Nashville Flight School, LLC, dba Nashville Flight Training or its trustees, employees, students, and agents. I FURTHER AGREE TO INDEMNIFY AND HOLD HARMLESS Nashville Flight School, LLC, dba Nashville Flight Training and Nashville Pilot Camp, ITS TRUSTEES, OFFICERS, EMPLOYEES, STUDENTS, AND AGENTS FROM ALL CLAIMS, DEMANDS, SUITS, CAUSES OF ACTION, OR JUDGEMENTS WHICH PARTICIPANT OR I EVER HAD, NOW HAVE, OR MAY HAVE IN THE FUTURE OR WHICH OUR HEIRS, EXECUTORS OR ADMINISTRATORS, OR ASSIGNS MAY HAVE, OR CLAIM TO HAVE AGAINST FLIGHT TRAINING, LLC, ITS TRUSTEES, OFFICERS, EMPLOYEES, STUDENTS, OR AGENTS, ARISING OUT OF OR IN ANY WAY CONNECTED WITH THE CAMP FOR ALL PERSONAL INJURIES, KNOWN OR UNKNOWN, PROPERTY DAMAGES (INCLUDING LOST OR STOLEN PROPERTY), OR CLAIMS FOR WRONGFUL DEATH, CAUSED BY THE ACTS, OMISSIONS, OR NEGLIGENCE OF Nashville Flight School, LLC, dba Nashville Flight Training, ITS TRUSTEES, OFFICERS, EMPLOYEES, STUDENTS, OR AGENTS, AND ON Nashville Flight School, LLC, dba Nashville Flight Training AND IN Nashville Flight School, LLC, dba Nashville Flight Training and Nashville Pilot Camp s NAME DEFEND AT MY OWN EXPENSE ANY SUCH CLAIMS, DEMANDS, SUITS, CAUSES OF ACTION OR JUDGEMENTS DESCRIBED ABOVE. I ALSO AGREE TO BE RESPONSIBLE FOR ANY PROPERTY DAMAGE OR PERSONAL INJURIES THAT PARTICIPANT OR I MAY CAUSE BY INTENTIONAL OR NEGLIGENT ACTS WHILE PARTICIPATING IN THE CAMP. I have read and executed this document with full knowledge of its legal significance. By: Parent/Legal Guardian Signature Date Parent/Legal Guardian Name Printed Minor Participant s mailing address: Street Address City/State Zip Code

7 PHOTO RELEASE PARTICIPANT AND I hereby grant to Nashville Flight School, LLC, dba Nashville Flight Training the right to reproduce, use exhibit, display, broadcast, distribute, and create derivative works of flight school related photographs or videotaped images of Participant for use in connection with the activities of the school or for promoting, publicizing or explaining the school or its activities. This grant includes, without limitation, the right to publish such images in the school s newsletter, on their websites, and public relations/promotional materials, such as marketing and admissions publications, advertisements fund-raising materials and any other school related publications. These images may appear in any of the wide variety of formats and media now available to the school and that may be available in the future, including but not limited to, print, broadcast, videotape, CD-ROM, and electronic/online media. All photos taken are without compensation to the participant. All electronic or non-electronic negatives, positives, and prints are owned by the school. I have read and executed this document with full knowledge of its legal significance. By: Parent/Legal Guardian Signature Date Parent/Legal Guardian Name Printed Minor Participant s mailing address: Street Address City/State Zip Code

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