Request and Indemnification

Guest Pilot Permission and Indemnification Form

Permission Request and Indemnification For Use of Van Aire Skyport Facilities For Guest Pilots, Passengers, and Visitors

Guest Pilot Form Completion Guide
PILOT’S INDEMNIFICATION FORM

PILOT’S INDEMNIFICATION FORM

1. I , by this statement certify that is my guest and is authorized to visit and operate an aircraft or participate in activities at Van Aire Skyport (CO12) in accordance with the provisions of the VASC Articles of Incorporation, the Declaration and Covenants, and the Airport Operating Rules and Regulations.

2. I understand that Van Aire Skyport (C012), is a private airport and not regulated by the U.S. Federal
Aviation Administration. I understand that I operate an aircraft or participate in other activities at this airport
as a guest, free of charge, at my own risk. I have read and will comply with the published VASC Airport
Operating Rules and Regulations to the best of my ability.

3. This means that I willingly and knowingly waive any later claim (other than willful or wanton misconduct)
against Van Aire Skyport Corporation, its board of directors, members, residents, or guests for any
alleged illness, injury, death, or property loss associated with my use of the Van Aire Skyport facilities.

4. By my signature below, I accept full responsibility for any casualty loss, damage or injury to any person, or
corporate or private property within the confines of the covenanted corporate jurisdiction, and will indemnify
any injured party against any and all costs incurred in recovering damages resulting from my negligence or
error while using the airstrip or common area facilities.

GUEST PILOT-IN-COMMAND

Sign Here

GUESTS / PASSENGERS

1. I have read and fully understand the foregoing Release and Indemnification document. I have been
informed of and am fully aware of the responsibilities and risks of participating in activities at this airport.

2. I understand that Van Aire Skyport (C012), is a private airport and not regulated by the U.S. Federal
Aviation Administration. I understand that I participate in activities at this airport as a guest, free of charge,
at my own risk.

3. This means that I willingly and knowingly waive any later claim (other than willful or wanton misconduct)
against Van Aire Skyport Corporation, its board of directors, members, residents, or guests for any
alleged illness, injury, death, or property loss associated with my use of the Van Aire Skyport facilities.

4. By my signature below, I accept full responsibility for any casualty loss, damage or injury to any person, or
corporate or private property within the confines of the covenanted corporate jurisdiction, and will indemnify
any injured party against any and all costs incurred in recovering damages resulting from my negligence or
error while using the airstrip or common area facilities.

Note: Any person under the age of 18 years must be authorized in writing by her/his parent or legal guardian
to participate in activities at Van Aire Skyport as a passenger or student pilot. A signed copy of that
authorization must accompany this document.

Passenger 1

Enter the full legal name of Passenger 1, confirm the date, and have Passenger 1 sign below to acknowledge and agree to the terms of this form.

Sign Here

Passenger 2

Enter the full legal name of Passenger 2, confirm the date, and have Passenger 2 sign below to acknowledge and agree to the terms of this form.

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Passenger 3

Enter the full legal name of Passenger 3, confirm the date, and have Passenger 3 sign below to acknowledge and agree to the terms of this form.

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Passenger 4

Enter the full legal name of Passenger 4, confirm the date, and have Passenger 4 sign below to acknowledge and agree to the terms of this form.

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Passenger 5

Enter the full legal name of Passenger 5, confirm the date, and have Passenger 5 sign below to acknowledge and agree to the terms of this form.

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Passenger 6

Enter the full legal name of Passenger 6, confirm the date, and have Passenger 6 sign below to acknowledge and agree to the terms of this form.

Sign Here

Passenger 7

Enter the full legal name of Passenger 7, confirm the date, and have Passenger 7 sign below to acknowledge and agree to the terms of this form.

Sign Here
Sunset over Van Aire Skyport

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