Skydive Booking Form Zoe`s Place – any date

Reservation Form
If you are jumping with others please attach a list of group members and tick here
Please note each individual jumper must have their own reservation form
(You may photocopy this form but it must be both sides on one sheet of paper)
Please complete this form (in BLOCK CAPITALS and black ink) and return it to the address below as
soon as possible. Please also provide your £50 booking fee via cheque (payable to Zoë’s Place
Trust) or credit card details (see below). This £50 will be deducted from your £450 sponsorship pledge
therefore you are requested to pledge to raise £400 on top of this fee to cover all costs. The £400 is
requested to be paid to Zoë’s Place Baby Hospice at least 14 days before you jump.
Please give your preference for your jump date:
1st Choice Date
2nd Choice Date
How did you find out about the jump? If from a newspaper,
website, company or charity newsletter please specify _________________________________________
Title __________First Name ________________________________ Surname _____________________
Address _____________________________________________________________________________
__________________________________________________________ Post Code _________________
Email Address (Please specify as this will be our primary source of contact)
_______________________________________________Occupation____________________________
Home Tel No__________________________________Mobile No _______________________________
Male/Female __________
Date of Birth ____________
Height ________________
Weight _____________
I enclose a cheque payable to ‘Zoë’s Place Trust’
Please Charge my Visa / Mastercard / Delta / Switch with the following amount £ _________
Card Number
Valid From
Expiry Date
Issue No
(switch only)
____ / ___ ____ / ___
_______
IMPORTANT: I confirm that I have read the Booking Terms and Conditions, Medical Restrictions,
Insurance and Important Notice overleaf and I understand and agree to be bound to those terms
and conditions and to comply fully with the same.
Signature__________________________________Date ______________________________
Tick here if you do not wish to receive details of other offers from either the charity or other organisations
Please complete and send this form along with your deposit to:
Zoë’s Place Baby Hospice
Easter Way
Ash Green
Coventry
CV7 9JG
Please read all sections of this page carefully
before signing the declaration below
Tandem
Booking Terms and Conditions
1. Your £450 sponsorship pledge is made up of; a £50 booking fee made payable by yourself and goes towards your sponsorship;
£230 skydive training fee and £220 sponsorship towards our charitable objectives. Any money raised over £450 is classed as
additional sponsorship and goes directly to provide care so any excess over £450 is more than worthwhile. Please note matched
funding from companies cannot be included in your £450 sponsorship pledge – unless it is paid prior to your
participation in the skydive.
2. In order for you to cover the cost of the training and the jump, you must pledge to raise sponsorship of £400 (not including your
booking fee).
3. After you have booked and paid your £50 booking fee, the remaining £400 must be paid to Zoë’s Place Baby Hospice at
least 14 days prior to your skydive date (see point 4 for online fundraising) This payment is totally non-refundable even if you
do not jump for any reason – we can however transfer your jump to an alternative date if required. In some cases, particularly if
the cancellation of your jump is made close to the jump date, the Skydive Centre may charge a fee of £70 which will be passed on
to the participant. If the money is not received by Zoë’s Place Baby Hospice 14 days before your jump date, you may NOT
be allowed to jump and you may have to re-arrange your jump date once the £400 is paid in full. Money can be paid by a
guaranteed cheque or by cash which must be sent to Zoë’s Place Baby Hospice so that it arrives 14 days before your jump.
Alternatively payments can be taken by credit/debit card over the phone 02476 361675. If you have not managed to raise £450 in
total on time you will have to book an alternative date in the future, or you could pay the outstanding balance from your own
bank account to ensure you can jump on your original date. This is in place to protect Zoë’s Place charity against financial
loss.
4. If you raise money via an online fundraising page such as www.justgiving.com all your sponsorship will come directly to our bank
account. Therefore if you have raised £400 14 days before your jump you will be able to take part on the date you requested. If
you have only raised part of the amount required on your online page then you will still need to pay the outstanding balance. Any
offline funds need to arrive at the Hospice 14 days before the jump or can be paid onto your online page by banking the money
into your own account and then paying it onto the online page via your credit/debit card. If there is any money outstanding you will
be expected to pay the difference yourself to ensure you can jump on the date you have booked.
5. All booking fees of £50 are completely non-refundable. However, it is valid for twelve months from the date of booking and should
you be unable to complete your jump due to inclement weather alternative arrangements will be made via you and the airfield.
6. All participants are required to make their own travel arrangements to and from the skydive centre and the cost of travel is
responsibility of the participant. Please note that a representative from the charity is unlikely to be present at the skydive centre on
the day of your jump.
Medical Restrictions
For a tandem skydive you must be at least 16 years old and must weigh under 15 stone (fully clothed) with your weight in proportion
to your height. (see http://www.theparachutecentre.com/weight_limits.php) The principal medical restrictions are diabetes, epilepsy,
fits, recurrent blackouts, heart or lung disease, mental illness and some cases of asthma but if you are in any doubt please contact us
for further information on 02476 361675. You will be required to sign a medical form before your jump declaring your fitness to take
part - this will be sent to you upon receipt of your reservation form but is also available on request. Those under the age of 18 will
need the medical form signed by a parent or guardian; those aged 40 and over, or those with a medical condition, will need it signed
by their doctor prior to your jump and bring this along with you on the day of your jump.
Insurance
On payment to the parachute centre of the fee for the training and the jump, all jumpers are covered by the British Parachute
Association Liability Insurance Policy up to £2 million for liability to Third Parties. Please note that this does not cover you or your
dependants for personal injury including death. You are therefore strongly recommended to take out your own insurance cover for
personal accident benefits to whatever level you consider appropriate. If in any doubt you should seek independent advice.
IMPORTANT NOTICE - Parachuting is an adventure sport and participation in such sports necessarily involves a risk of injury or
death regardless of the standard of training, supervision and equipment employed. I voluntarily accept all the risks inherent in the
sport and I agree for myself and my personal representatives to indemnify and hold harmless Zoë’s Place Baby Hospice and
Skydive Tilstock against any claim or claims whether on my own account or from third parties arising out of any accident or incident
resulting in any loss or damage (including bodily injury and death).
I confirm I have read all the above sections marked Booking Terms and Conditions, Medical Restrictions,
Insurance and Important Notice, and I understand and agree to be bound to those terms and conditions and to
comply fully with the same.
Name_______________________________ Signature______________________________ Date________________