Pilot Affirmation of Currency new

Pilots - Thank you for affirming pilot in command eligibility below.

Please complete and sign prior to each dream flight.
*Required Field
I certify and confirm 'NOT' to act as a Pilot in Command for any Above the Clouds flight referred to me unless I, at the date and time of each flight I am incompliance with the following:
- I have a minimum of 300 hours total flight time and have 50 hours of flight time during the last 12 months.
- I am instrument rated (IMC flight currency not required)
- I am current with all FAR Part 61 requirements appropriate to the license held
- I hold a current and valid medical certificate.
- I am in compliance with all Federal Regulations related to the use of alcohol, and drugs, including reporting requirements specified in the regulations.
- I have in force liability insurance applicable to the flight providing minumum coverated of $1,000,000 per occurrence and $100,000 per seat, for the specific aricraft to be flown.
- I am flying an airplane with a valid standard airworthiness certificate, ASEL, AMEL, and/or ROTORCRAFT and have complies with all inspections, ADs and SEs.
- As of the date of the Dream Flyer Day or Discovery Flight Day that this form applies to, I am 74 years of age or younger, or have a written waiver to fly from the Above the Clouds Safety Committee.
I certify that all the above affirmations are TRUE at the time of the flight*

YesNo
Today's Date*

MonthDayYear
Date
Name*

First NameMiddle Name or InitialLast Name
Email*
example@example.com
Enter Initials here to affirm the above*
Tail number of plane you will be using (optional)
Thanks you for Volunteering for Above the Clouds and sharing your passion for flying with kids. You are making a difference in their lives!
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Pilots - Thank you for affirming pilot in command eligibility below.