Pilot/Aircraft Liability Waiver

= Pilot and Aircraft Profile Liability Waiver

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Check One: ( ) Initial Application<= span style=3D'mso-spacerun:yes'> = ( ) Updating Information

Attention: By submitt= ing this form, you accept responsibility for ensuring you are in compliance with all Federal Aviation Regulations including but not limited to flight curren= cy, required licensing, pilot health, and aircraft registration and airworthiness. A copy of your Aircraft Owner/Renter Liability Insurance must be on file with Flying Paws. Please sign the second = page and return all documentation to Flying Paws as instructed at the end of this document. Thank you for being= a Flying Paws volunteer.

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Pilot Name: _______________________________________ &= nbsp; Phone #1 _____________

Street Address: ____________________________________ &= nbsp; Fax: _____________

City, State, Zip: ____________________________________= = Cell Phone: ___________

= &nb= sp; ____________________________________= Email: __________________

Emergency Contact: _________________________________ Phone Number: _________

&nbs= p; &= nbsp; Relation: ______________________________

Ratings: ___________________________________________

Availability: (Circle One): Weekday<= span style=3D'mso-spacerun:yes'> Weekends

Distance Willing To Fly: (Circle the Greatest) Less th= an 300 nm,

300-500nm ,Grea= ter than 500nm

Airport Restrictions:= (Circle) Paved Runway, Runway longer than 5,000 ft,

&nbs= p; &= nbsp; Controlled, Airport Elevation Less Than 5, 000 ft,

&= nbsp; &nbs= p; Other: ___________________________________

Aircraft #1 &= nbsp; &nbs= p; &= nbsp; &nbs= p; Aircraft #2

Tail Number: __________________________ &= nbsp; Tail Number: ____________________________

Aircraft Type/Model: ____________________ = Aircraft Type/Model: __________________= ____

Color: ________________________________ = Color: ___________________________________

Airport Based At: _______________________ Airport Based At: _________________________

&nbs= p; Identifier: _______________________ &n= bsp; = ; Identifier: _________________________

FBO Name: ____________________________ FBO Name: ______________________________

&nbs= p; Contact: _________________________ = &nb= sp; Contact: ___________________________

&nbs= p; Phone Number: ___________________ &nbs= p; &= nbsp; Phone Number: _____________________

Circle One: &nbs= p; Rent or Own &= nbsp; &nbs= p; &= nbsp; Circle One: Rent or Own

Cruise Speed: (Circle One) Under 100nm/hr, &n= bsp; Cruise Speed: (Circle One) Under 100nm/hr,

&nbs= p; &= nbsp; 100-150nm/hr, 150- 200nm/hr = &= nbsp; 100-150nm/hr, 150-200nm/hr,

&nbs= p; &= nbsp; Over 200nm/hr = ; &n= bsp; = ; &n= bsp; Over 200nm/hr

Pressurized: Yes or No &n= bsp; = ; &n= bsp; = ; Pressurized: Yes or No

Fuel Capacity: ______________________ = Fuel Capacity: _______________________

&nbs= p; Burn/Hr Cruise: _______________ &n= bsp; = ; = Burn/Hr Cruise: ________________

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Page 2 of Pil= ot and Aircraft Profile Liability Waiver

Total Useful Load: _____________________ &= nbsp; Total Useful Load: ______________________

&nbs= p; Useful Load Rescue Weight: ________ &nb= sp; = Useful Load Rescue Weight: ________

Additional Information: ________________________________________________________________

Liability Waiver for P= ilot Volunteers

Flying Paws is= an all volunteer organization. Flyin= g Paws pilots, flight crews and ground crews voluntarily provide free air transpor= tation in privately owned or rented aircraft for special needs rescue animals. Flying Paws does not financially reimburse the pilots, flight crews or ground crews for any expenses for the= se flights. Ground crews provide= help with promotions, educational programs and emergency ground transportation f= or veterinary care of the animals in transit.= No personal expenses are reimbursed.

I, the undersi= gned Flying Paws volunteer, agree to waive and do waive and release Flying Paws,= its officers, directors and other volunteers from any and all claims including,= but not limited to liability for negligence, any personal injury or property da= mage that might be suffered, and any wrongful death actions which an estate might bring, arising out of injury during any Flying Paws flight or activity. It = is understood and acknowledged that my signing this Waiver of Liability is bou= nd and effective for any and all Flying Paws flights or activities. I further understand that the pilo= t in command (PIC) of any Flying Paws flight has the final decision concerning t= he cancellation of the flight due to weather, mechanical problems or for any reason whatsoever, if in their judgment the flight can not be completed in a safe manner. Flying Paws requ= ires that the pilot of any VFR or IFR flight be current, hold the correct certificate, maintain currency, medical certificate and meet all of the FAA regulations required for that flight. The aircraft must meet all requirements for the flight undertaken. The PIC has the option to have a n= on-pilot or another pilot to fly with them provided that they have signed the Liabil= ity Waiver and it is on file with Flying Paws.= The providing of any transport is totally voluntary and if there is = any reason whatsoever that the flight can not be completed in a safe manner: the flight is to be cancelled or postponed.&nb= sp; I understand that the animals must be transported in appropriate ken= nels and must be accompanied by all required paperwork. Kennels are provided by the pilot = due to the different configurations of the aircraft and remain the property of the pilot. Should an animal be transported outside of a kennel, it is the PIC who will determine whether t= he flight will happen. Flight sa= fety determines any and decisions by the PIC.

Signature: ____________________________________________________ Date= : ______________

Printed Name: _________________________________________________

Please email completed form and a scan of your insuran= ce policy to pilots@ = . OR, mail these documents to Flying Paws P.O. Box 4798 Chino Valley, AZ 86323

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