Participant Information Form

Before you complete the form has the person flying flown with us before?

Yes

We may have their details already. Please telephone the Aerobility Front Desk on 0303 303 1230 or email frontdesk@aerobility.com before proceeding.

Name of person completing the form*

First NameLast Name

Your Email*

example@example.com

Are you the person who will be flying?

Yes

Name of person flying*

First NameLast Name

Would you like to purchase an Aerobility Gift Voucher for an experience flight? If so, please select which voucher you would like

We will then send you an email with a link to pay for the voucher

Group Name if part of a Flying Day

Leave blank if not applicable

Date of Flying Day if part of a Group

Leave blank if not applicable

Ablenet Voucher number (if applicable)

Leave blank if not applicable

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email*

Phone Number*

Date of Birth*

Date

Gender*

What is your ethnic group?*

Aerobility uses this data to help develop its services, ensuring they are as accessible as possible to as many people as possible

Are or were you a member of the Armed Services?

ArmyRoyal NavyRoyal Air ForceRoyal Marines

Please provide your military number (if applicable)

Secondary contact name and relationship to you (if applicable)

We will need a secondary contact if the person who is flying is under the age of 16 OR is unable to communicate with us directly

Secondary contact phone number (if applicable)

Secondary contact email (if applicable)

Please select if all communication should be via the secondary contact named above

Next of Kin/Emergency Contact*

Name and relationship to you

Next of Kin Phone*

Please provide a telephone number

Next of Kin Email

Please provide an email address or leave blank if none

Please indicate which base you would like to fly from:

Blackbushe (South)Tatenhill (Midlands)Lydd (South East)

For operational reasons we need to store your details for you to fly with us. We will take all reasonable steps to protect your data and we will only contact you in relation to your flight. If you subsequently begin pilot training with us we will need to make your computerised student records accessible to our staff and instructors, including with flying schools that Aerobility partner with, so that you can fly at any of our affiliated bases. Please select yes to consent to this. *

Since you have indicated that you would like to fly from Lydd we will need to share your details with Lydd Aero Club for operational reasons. Please select the box below to show that you agree to this.*

I agree to Aerobility sharing my details with Lydd Aero Club

Lydd Aero Club email for cc of form

example@example.com

Since you have indicated that you would like to fly from Newquay we will need to share your details with Flynqy for operational reasons. Please select the box below to show that you agree to this.*

I agree to Aerobility sharing my details with Flynqy

We promise that your details will only be used as you wish and in line with data protection law. We will never share your details with another organisation or contact you in a way you have not agreed to. However, we would like to send you communications from time to time about our organisation. If that would be ok, please tick if you are happy for us to contact you by:

EmailTelephoneSMSPost

If you don't want to hear from us, or change your mind about how we contact you, please email frontdesk@aerobility.com or call 0303 303 1230. For more information on how we manage your data, please see our privacy policy.

Medical Declaration

Please provide the information below that will help Aerobility's Instructors and staff to assess your needs. We are happy to discuss any questions or concerns you may have prior to the flight.

Height (in cm)*

Height (formatted)

This will be completed automatically

Weight (in kg)*

Weight (formatted)

This will be completed automatically

Please explain the nature of your disability/condition including mobility limitations*

Please view this short video for information about accessing our aircraft

Please tick any that apply

I may require a hoist to enter and exit the aircraftI can transfer from one chair to another with or without assistance (if applicable)I am prone to seizuresI can experience uncontrolled movementI can exhibit challenging behavioursI am claustrophobicI may experience a moderate or extreme allergic reactionI carry an EpiPen or equivalent

Please add further details if you are at risk of an allergic reaction while visiting us

By ticking yes below, you are confirming that you have read and understood the mandatory safety rules and are giving your consent to fly. You have also read and agree to the statement of expectations for participants (both available at the top of this form)*

Yes

For Aerobatic Flights you may experience forces between +4g positive and -1g negative, so please ensure that you are fit enough to cope with these forces (like being on a rollercoaster) and discuss any concerns fully with the instructor before the flight.

Please indicate if you are happy for us to take photographs which may be used in our promotional material (eg social media, Aerobility magazine, press releases)*

YesNo

I hereby declare to the best of my knowledge that I neither have (nor have been diagnosed with) any medical condition which could cause an adverse effect during flight. I further declare that I have no known medical condition which is likely to be exacerbated by the forces exerted on my body during flight. Should I proceed with a flight with a medical condition, I do so at my own risk and I understand that the instructor may be unable to provide assistance while flying the aircraft and that it will take time to get the aircraft to the nearest airfield should any medical assistance be required. I understand that in the event of an emergency evacuation, I may not be able to exit the aircraft until assistance arrives. On behalf of myself/my child I confirm that I have read and understood this declaration of fitness to fly. Typing your name below will act as a signature agreeing to this statement.*

If you are unsure whether or not you can sign the above declaration due to your condition, you should consult your GP. Please contact us for a form that can be signed by your GP to record his/her opinion. Please call us on 0303 303 1230.

If the participant is unable to sign or indicate themselves verbally to the pilot instructor, please indicate how the participant has expressed their wish to fly