Registration and Waiver Form
The 2015 ASI Cross-Country Camp
Name: ______________________________________________________________
Telephone: __________________________________________________________
Email: ______________________________________________________________
Mailing Address: _____________________________________________________
_____________________________________________________
Fees:
Single Pilot:
Additional Pilot:
 $300 Full Camp Fee
 $150 Full Camp Fee
OR
OR
 $50 Deposit ($250 balance due)
 $50 Deposit ($100 balance due)
Please make all checks payable to Air Sailing, Inc. Includes six days classroom sessions, course materials and complimentary guest
membership. Full camp fee includes $50 registration fee, non-refundable for registrants who cancel less than two weeks prior to the
event. Tows and incidentals (i.e. aero-retrieves, oxygen, banquet, etc.) not included.
Glider Registration #: N___________________ Make & Model: ___________________
Glider Owner: __________________________ Annual Inspection Date: _____________
Liability Insurance Carrier and Policy #: ____________________________________
Note: Bring or mail two copies of your insurance summary of coverage page to camp.
We will need to attach one to your Air Sailing Waiver of Liability and you will need to
carry one in your glider. See the next page for our insurance requirements.
Pilot Certificate #:________________________
Your Ratings:
 Private
 Commercial
Flight Review Date: ______________
 CFIG
 Power Category
Club/Gliderport Affiliation: _________________________________________________
Experience: Total Hours ______
Solo Glider Hours______
Cross-Country Flights: ______
Landouts _______
 Bronze Badge  Silver Altitude
 Gold Distance  Diamond Goal
Current ASI member:  Yes /  No
Glider Flights ______
 Silver Distance  Silver/Gold Duration
 Diamond Distance
Have Air Sailing Field Checkout:  Yes /  No
Signature: ___________________________________________________________
Make check payable to Air Sailing, Inc. and mail with Registration Form to:
David Prather, 2015 Camp Manager
3179 Boeing Road
Cameron Park, CA 95682
dwprather68@yahoo.com / (530) 748-7275 Cell
Registration and Waiver Form
TO:
FROM:
DATE:
RE:
Pilots and Aircraft Owners operating at the Air Sailing Gliderport
Air Sailing, Inc. Board of Trustees
07-FEB-15
Insurance Requirements for Aircraft Operating at Air Sailing Gliderport
All pilots and all owners of aircraft operating at the Air Sailing Gliderport
continue to be required to provide proof of acceptable aircraft insurance.
Acceptable aircraft insurance is current and valid owned-aircraft insurance and/or
current and valid non-owned aircraft insurance with coverage in the amounts of
$100,000 minimum per person or per passenger bodily injury liability, $1 Million
minimum property damage liability, and $1 Million minimum each accident or
occurrence, or otherwise mutually acceptable aircraft insurance. Proof of acceptable
aircraft insurance is an original or copy of the policy coverage summary page and
pilot(s) endorsement(s) showing the named insured(s) or an original or copy of a
certificate of insurance showing the named insured(s), or otherwise mutually
acceptable proof of insurance, in the pilot’s physical possession or readily accessible
in the aircraft and attached to the pilot’s ASI Waiver of Liability.
Obviously, Air Sailing must provide an exemption from this requirement for land
outs and other transient pilots and aircraft, but these pilots and owners should be
made aware of the requirement for future reference.
For questions or comments regarding these insurance requirements please contact
David Volkmann at drvolkmann@charter.net or 775-787-3197.
Registration and Waiver Form
Waiver and Assumption of Liability
Please enter me as a Participant in the 29th Annual Air Sailing Cross-Country Camp (Camp,
hereafter) to be held on or about June 7 through June 12, 2015 at the Air Sailing Gliderport in
Washoe County, Nevada. In consideration of acceptance of this entry, I hereby agree to be legally
bound, for myself, my heirs, executors, administrators, representatives, successors or assigns and
agree to waive any and all rights and claim for damages which I may have against Air Sailing,
Inc., the Trustees of Air Sailing, Inc., the Camp Manager(s), or Camp Lead Pilots, or their agents,
representatives, successors or assigns for any and all injuries or death suffered by me or by any
member of my crew during the Camp. I further agree to assume full responsibility for and to hold
the aforementioned entity and persons free and harmless from any and all obligations for
damages to persons or property done by my crew or me.
I fully understand and agree that I am waiving any claims for damages for which I may suffer by
virtue of any act of negligence arising in the future by any commission or omission of any of the
aforementioned entity or persons or their agents, representatives, successors or assigns and that
the consideration for this waiver is the permission of Air Sailing, Inc. allowing me to participate
in said Camp and that such permission is being granted me in the reliance upon this waiver.
Participant _____________________________________________ Date ________________
Signature ____________________________________________________________________
Location _____________________________________________________________________
Permission of Parent or Guardian for Participants less than 18 Years Old
I, the parent or guardian of the above-named pilot of less than eighteen years of age, do hereby
join with said pilot in the above Waiver and Assumption of Liability and I do hereby certify that I
have read and understand the above Waiver and Assumption of Liability; furthermore, I do
hereby accept said waiver without reservation and I do hereby grant my permission to the abovenamed pilot to participate in the aforementioned Camp.
Parent or Guardian _____________________________________ Date ________________
Signature ____________________________________________________________________
Location _____________________________________________________________________
Registration and Waiver Form
Emergency Contact Info / Field Contact Info
(Fill out once on field if you prefer)
In Case of Emergency:
Contact ___________________________________ Relationship _____________________
Phone _____________________________ Alt Phone_______________________________
Address ____________________________________________________________________
_____________________________________________________________________
Medical Factors:
Pertinent Aero-Medical issues you wish to communicate to camp staff or medical issues that may
arise during a remote landout:
______________________________________________________________________________
______________________________________________________________________________
On-Field Info/Retrieve Info:
Staying overnight on field:  Yes /  No
Location _________________________________
Vehicle Description: __________________________________ License #: ________________
Trailer Description: ___________________________________ License #: ________________
Ball Hitch:
 1 7/8”
Electrical Connector:  Flat 4
 2”
 other
 Round 4
 other
Do you authorize any camp staff or participant to operate your vehicle/trailer to retrieve you:
 Yes /  No
Trailer/Vehicle Key Location: _____________________________________________________
Additional Instructions: __________________________________________________________
______________________________________________________________________________