Name: Skydive Lancaster
Address: 1071 Schaeffer Rd, Lebanon, PA, 17042, US
Telephone: (717) 742-0809
Price range: $$

Please read the waiver below and submit the following information to complete your waiver:

Name*
First Last
Age (years)*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email*
Phone*
Driver's License/ID #*
Birthday*
MM slash DD slash YYYY
Height (in.)*
Weight (lbs.)*
Medical Insurance Company
Policy/ID #
Insurance Phone #
Emergency Contact Person*
First Last
Emergency Contact Phone*
Secondary Emergency Contact Person
First Last
Secondary Emergency Contact Phone
Blood Type
Medications
Allergies to Medications
Complete the following section only if you are a licensed jumper:
USPA License #*
USPA Membership #*
USPA Expiration*
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OR, click here if you have a lifetime membership.
- Lifetime Membership
Jumps in Last 6 Months*
Last Reserve Repack*
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Gear Checked By (SL Member)
First Last
Upload a Picture of your Reserve Card*
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Signature
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Signature*
Today's Date*
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Skydive Lancaster Waiver

Complete the following section only if you are a licensed jumper: