Please fax or mail this form to the office before your flight departs! Flight Authorization, Liability Release and Indemnity Form
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- Please FAX or MAIL this form to the office BEFORE your flight departs! Flight Authorization, Liability Release and Indemnity Form
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Angel Airlift Mid-Atlantic FAX: 757-318-9107 462 4620 Haygood Road, Suite 1 OFFICE: 757-318-7149 Virginia Beach, VA 23455 VOICEMAIL: 800-296-3797 WEBSITE: www.angelflightmidatlantic.org Email: mj@angel-flight.org 
Please FAX or MAIL this form to the office BEFORE your flight departs! Flight Authorization, Liability Release and Indemnity Form PILOT: ________________________________CO-PILOT: ________________________________DATE: ______________ AIRCRAFT/VEHICLE MAKE AND MODEL: ___________________________________ REGISTRATION NO.: ___________ PASSENGER NAME(S): _______ ________________ (Please Print) I, the undersigned, am a passenger and/or the parent or legal guardian of one or more minor or disabled passengers, and I execute this release voluntarily to bind myself as a passenger and/or to bind all minor or disabled passengers of whom I am the parent or legal guardian (along with myself, all of the foregoing are referred to herein collectively as the “Passenger”). The Passenger understands that Angel Airlift Mid-Atlantic, Inc. (referred to herein collectively with its parent, subsidiaries, divisions and affiliates as “Angel Airlift”) has arranged one or more flights or other transportation, free of charge, for the Passenger’s convenience in obtaining, assisting with, or returning from medical treatment or diagnosis, or for other compelling humanitarian needs and flights of compassion as are determined suitable for Angel Airlift missions (the “Transportation”). The Passenger understands that the pilot, co-pilot, operators, owners and lessors of the aircraft and other vehicles in which the Passenger will ride (all of the foregoing are referred to herein collectively as the “Volunteers”) are volunteering their services, time, skills, flight, aircraft, vehicles, and other related costs and expenses for the Transportation, and that they are not reimbursed for their costs, expenses, or services. As such, the Passenger understands that Angel Airlift and the Volunteers, and the other Released Parties (as defined below), are relying on the Passenger’s release for their agreement to provide the Transportation. The Passenger also acknowledges that the Passenger is flying on the aircraft or riding in the vehicles voluntarily of Passenger’s own free will and desire. In consideration of the furnishing of the Transportation, services, time, skills, aircraft, vehicles, and other related costs and expenses being arranged and provided, the Passenger hereby agrees to forever release, discharge, indemnify, defend and hold harmless the Volunteers, Angel Airlift, and each of their respective divisions, parents, subsidiaries, wings, member organizations, affiliates, chapters, officers, directors, agents, employees, volunteers, insurers, heirs, assigns and successors in interest, and any and all entities who referred me to Angel Airlift (all of the foregoing are referred to herein collectively with the Volunteers and Angel Airlift as the “Released Parties”), from any and all claims, demands, liability (under the law of any state or country), fees, expenses, and costs of any kind whatsoever, including attorneys’ fees, that the Passenger may have or claim to have on account of or in any way related to or, directly or indirectly, arising from the proposed or actual Transportation, the cancellation or delay of the Transportation, and/or the failure to provide initial or return Transportation of the Passenger. The Passenger further agrees not to sue on any claim, or instigate any action, related to or arising out of the Transportation. The Passenger’s release specifically includes, but is not limited to, any and all alleged or actual intentional and negligent acts, errors, and omissions of any of the Released Parties. In addition to any form of economic damages, costs and expenses, this release also specifically covers any and all injuries, deaths, and conditions of health, whether or not immediately apparent, following, arising out of or related in any manner to the Transportation, or which may at any time thereafter develop. As evidenced by the signature below, the Passenger regards the Transportation, services, time, skills, aircraft, vehicles, and other related costs and expenses being furnished to the Passenger by the Released Parties as significant, material, and valuable consideration in exchange for this release, and the Passenger values this consideration as a significant, material factor in the Passenger’s well-being and physical prosperity. The Passenger has read and fully understands this release. The Passenger has talked with a mission coordinator or other persons associated with Angel Airlift about questions concerning the Transportation. In connection with any portion of this release that the Passenger did not understand, the Passenger understands that the Passenger had, and continues to have, the right to obtain legal advice from an attorney of the Passenger’s choice and that the Passenger has been encouraged to seek such legal advice. This release shall be binding upon the Passenger, the Passenger’s parents and/or guardians, and the Passenger’s heirs, assigns and successors in interest. This release may be enforced by any of the Released Parties, each of whom individually, along with their respective heirs, successors and assigns, is a third party beneficiary of this release. The Passenger acknowledges that this release shall be governed and interpreted by the laws of the Commonwealth of Virginia. PASSENGER SIGNATURE: __________________________________________________________ DATE: ___________ The Passenger hereby authorizes Angel Airlift Mid Atlantic and/or Mercy Medical Airliftto use the Passenger’s name and photographs in any reports of the flight that might appear in newspapers, radio, television, Angel Airlift Mid-Atlantic or Mercy Medical Airlift newsletter, or other public relations activities, unless the “no” line at the end of this paragraph is checked. ___NO Last updated 09/29/06 Directory: wp-content -> uploads -> 2017 2017 -> Leadership ohio 2017 -> Ascension Lutheran Church Counter’s Schedule January to December 2017 2017 -> Board of directors juanita Gibbons-Delaney, mha, rn president 390 Stone Castle Pass Atlanta, ga 30331 2017 -> Military History Anniversaries 16 thru 31 January Events in History over the next 15 day period that had U. S. military involvement or impacted in some way on U. 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