First Middle Last
Current Address_______________________________ ____________________ _________ ________
Street City State Zip
Proof of US Citizenship:
Document Number Expiration date
Drivers License _________________________________ ____________________, and
o Passport _____________________________________ _______________________, or
o Birth Certificate _________________________________ _______________________
Name on Card: _________________________________ Billing Zip code: ________________
Card Number: _________________________________ Date of Exp. ______
Security Code(On the back of the Card): _____________
Hourly Cost of Training:
Plane Rental: Simulator rental: Instruction:
$199/hr $60/hr $45/hr
I authorize investigation of all statements contained in this application.
I understand that the misrepresentation or omission of facts called for is cause for rejection at any time.
Signature of Applicant Date
Terms and Conditions for Training
1. I understand that I shall be responsible for:
a) Complying with all local, state, and federal regulations and airplane flight manual
b) Operating the aircraft under conditions consistent with my student pilot certificate and
c) Obtaining a current weather report and forecast.
d) Filing a flight plan for all non-local flights.
e) Obtaining a check list for the aircraft type to be flown.
f) Performing checks based on the appropriate checklist preflight, before take-off, and before
g) Inspecting and making a ground check of the aircraft before take-off. I may not take-off in the
aircraft unless it is in airworthy condition. During pre-flight inspection, any unusual damage
must be reported immediately – before flight — (if damage is noted during taxiing or take-off
return to the school at once) or I, the student, will be held responsible.
h) Maintaining the aircraft’s oil level to according to recommended guidelines:
i) Using the brakes only when needed and avoiding riding the brakes when taxiing.
j) Maintaining a minimum of one-hour fuel reserve, per tank, at all times. If fuel is purchased
away from the home base, then the cost will be reimbursed.
k) Taking provision for passengers who might get sick during flight. Should my passenger get
sick in the aircraft, I will be responsible for the aircraft cleaning fee.
l) Caring for Emerald Coast Aviation Flight Training aircraft as if it were my own so that the next pilot
cannot tell that the aircraft was flown before.
m) Returning the aircraft at the agreed upon time, weather permitting. I understand that late
fees may apply (with the exception of unforeseen weather, and mechanical delay) if I do not
return the aircraft at the agreed upon time.
n) At the end of each flight:
i. Returning and parking the aircraft on the Emerald Coast Aviation Flight Training ramp, and
placing the propeller in a horizontal position.
ii. Locking and latching all doors. I understand that if I fail to secure the aircraft properly, and any theft or damage occurs, then I will be responsible for all losses resulting therefrom.
iii. Securing all seatbelts.
iv. Covering the aircraft.
2. I agree to operate the aircraft in accordance with the following terms and conditions:
a) Weight and balance must be calculated prior to each flight and filed with Emerald Coast Aviation
Flight Training prior to each departure.
b) Only the named pilot is authorized to fly the aircraft as PIC. The PIC shall fly the aircraft from
the left seat.
c) Landing will only be on hard-surface runways at airports listed in the airport facility directory, unless otherwise directed by an Emerald Coast Aviation Flight Training Instructor
d) The aircraft must be properly secured when not in use.
e) All empty oil containers should be either thrown out or immediately placed in the plastic
buckets in the luggage compartment until proper disposal is possible.
f) Smoking, eating and drinking are prohibited on the ramp, and in the aircraft. The only
exception to this rule being water. Students are encouraged to carry a bottle of drinking
water with them on all flights in order to prevent dehydration.
g) Passengers are not permitted during flight using Emerald Coast Aviation Flight Training aircraft
h) The aircraft may not be used or operated:
i. For any illegal purposes;
ii. In any race, speed test or contest;
iii. In formation flight;
iv. Outside the limits of the continental United States, and Bahamas;
v. To carry passengers or property for monetary compensation or hire;
vi. If the student has used intoxicating liquids, or sleep-inducing drugs within twenty
four hours prior to the commencement of a flight; or
vii. For aerobatic maneuvers, unless instructed to do so by an instructor authorized to
conduct aerobatic training.
i) In the event of undue delay, deviation or any other circumstance, I must contact Emerald Coast Aviation Training immediately. Additionally, I must call for instructions and/or
work authorization in the event that the aircraft should require maintenance or repair work.
3. I authorize Emerald Coast Aviation to charge the above-mentioned Credit Card for services rendered(At the agreed upon rate mentioned above), that are not paid for at the time the service was received by the student. I understand that I will be billed for all time accumulated while the master switch is turned on, and the master switch must not ever be turned off during a flight. If there is a discrepancy, I will call it to the attention of one of the Emerald Coast Aviation Flight Training staff.
4. I understand that I am responsible for logging my own time and caring for all timekeeping records equipment, including, but not limited to:
a. Logging all flights and simulator times in the appropriate Hobbs book.
b. Returning equipment bags with clipboards, keys and Hobbs book to desk personnel.
5. I understand that if I am a student pilot, and have not flown at Emerald Coast Aviation Flight Training for a period of two weeks, then I will be required to fly with an instructor prior to any solo flight. As a
certificated pilot, if I have not flown at Emerald Coast Aviation Flight Training for a period of thirty days,
than I must fly with an instructor prior to any solo flight.
6. I am not permitted to carry passengers while in use of Emerald Coast Aviation Flight Training aircraft.
7. I agree to the following Administrative Policies:
a) I will be charged a “No Show Fee” for cancellation of each two-hour block reserved with an
instructor and/or aircraft without 24 hour notice.
b) I will be charged a $35.00 “Returned Check Fee” for any checks returned for insufficient or
c) All scheduling must be approved by Emerald Coast Aviation Flight Training desk personnel.
d) Students are advised to check the schedule after each flight to confirm the date and time of
their next lesson. Emerald Coast Aviation Flight Training will endeavor to provide aircraft and
instructors to meet customer requirements. However, due to the nature of the pilot training
business (i.e.: weather, mechanicals, check rides…), Emerald Coast Aviation Flight Training may,
without notice, need to cancel or re-schedule a lesson due to unforeseen contingencies.
e) Students must wear a headset when receiving flight instruction.
8. In the event that any policy of insurance, other than those held by Emerald Coast Aviation Flight Training, entitles me to coverage following any aircraft loss, my coverage will be primary and Emerald Coast Aviation Flight Training insurance will be secondary. Any payments received under such a policy of insurance will be payable to Emerald Coast Aviation Flight Training to the full extent necessary to repair or replace any property damaged in the claimed event.
9. I understand and agree that I am personally liable for the following:
a) For deductible hull coverage for any accident, incident, or loss involving pilot error, and/or
violation of FAR or Rental Agreement.
b) For the full costs of all damages or loss resulting from breach of this agreement, from
operations contrary to the Federal Aviation Regulations or Airplane Flight Manual, or from
any action which would invalidate or reduce the insurance coverage of Emerald Coast Aviation
c) Money, damages, costs, and reasonable attorney fees incurred by Emerald Coast Aviation Flight Training in the event suit is instituted to recover possession or to enforce any of the
terms, covenants, and conditions hereof.
I have read and understand the Emerald Coast Aviation Flight Training Safety Procedures, Course Catalog, and Student Agreement. I also understand that my signature attests to the fact that I have a copy of the approved syllabus for the course in which I am enrolled. I agree to comply fully with its contents.
Signature of applicant Date
Signature of Parent / Guardian Date
HOLD HARMLESS, INDEMNITY,
AND WAIVER OF LIABILITY
THIS DOCUMENT AFFECTS IMPORTANT RIGHTS. READ IT CAREFULLY. YOU MAY WISH TO SEEK LEGAL ADVICE BEFORE SIGNING. THIS RELEASE IS INTENDED TO BE A COMPLETE AND IRREVOCABLE RELEASE OF ALL POSSIBLE CLAIMS CAUSED BY NEGLIGENCE OR OTHER UNINTENTIONAL WRONGDOING.
I, (PARTICIPANT MENTIONED ABOVE) voluntarily desire to take an airplane, helicopter and/or other aircraft (collectively, “Aircraft”) ride, pilot an Aircraft, rent an Aircraft, and/or train to pilot an Aircraft (collectively, the “Activity”), as well as to participate in the associated activities including, but not limited to, boarding, deplaning and/or walking on the runway and/or around the Aircraft, etc. (the “Associated Activities”), with EMERALD COAST AVIATION(The “Company”). Such activities may result in bodily injury, death, and property damage. I understand and acknowledge that engaging in any of the above activities are purely voluntary and I have made the decision to participate of my own free will. I also understand and acknowledge that, but for my voluntary execution of this Release of Liability (“Release”), the Companies would not allow me to be in or otherwise near any Aircraft or participate in any Activity or the Associated Activities.
1. RELEASE AND COVENANT NOT TO SUE. I, on behalf of myself, my heirs, successors, assigns, agents, trusts, beneficiaries, executors, administrators, guardians, and legal representatives (individually or in any group; collectively, “Releasor”), hereby exempt, release, acquit, forever discharge, and hold harmless the Companies, their respective officers, directors, members, administrators, trusts, managers, agents, representatives, servants, employees, successors, and/or assigns (individually or in any group, “Affiliates” and collectively with the Companies, the “Releasees”), whether acting on behalf of the Companies, or individually, from any and all liability, claims, losses, payments, harm, damages, costs, demands, claims and expenses of every nature whatsoever (collectively, “Damages”), whether in contract or in tort or under any other legal theory, arising out of my participation in the Activity and/or any Associated Activities. Releasor further agrees not to make any claim against, sue, or attach the property of anyone or more Releasees for any bodily injury, death, loss, or damage to personal property, or other damages, including those resulting in whole or in part from the negligence of the Releasees or other acts or omissions of the Releasees resulting from my participation in any Activity and/or Associated Activities.
2. ASSUMPTION OF RISK. I am not required to participate in the Activity or any Associated Activities. I freely and voluntarily choose to assume all of the risks inherent in the Activity and the Associated Activities, including, but not limited to, risks of negligent conduct of others, equipment or aircraft malfunction, improper or negligent operation of Aircraft, including those risks resulting in whole or in part from the Releasees’ own negligence or unintentional acts, but excluding gross negligence or willful misconduct.
3. INDEMNITY AGAINST CLAIMS. Releasor agrees to indemnify, defend and hold harmless the Releasees against any and all losses, judgments, or damages, arising out of any claims, demands actions, causes of action, and/or proceedings of every nature whatsoever (collectively, “Claims”), including but not limited to attorney and legal fees at trial and appellate levels, which may be presented or initiated by any person or entity, arising out of my participation in any activity and/or Associated Activities, and/or concerning the enforcement of or legal challenge to this Release.
4. LEGAL. This Release is governed under Florida law, without regard to conflict of law principles. The exclusive venue for any action arising hereunder shall be in the state and federal courts located in Okaloosa County, Florida, and the parties hereby consent to the jurisdiction of such courts. In any action relating to this Release, Releasor hereby WAIVES ANY RIGHT TO A JURY TRIAL
Signature of applicant Date
If the Participant is under the age of 18, then I, (PARENT/GUARDIAN NAME MENTIONED ABOVE) as the Parent/Guardian of the above-said minor, do hereby (i) consent to him/her participating in the Activity and/or any Associated Activities with the Releasees; (ii) agree to and adopt as my own, on behalf of myself and the above Releasor, the conditions of the above Release.
Signature of Parent / Guardian Date