Passenger Manifest

PASSENGER MANIFEST
How many passengers? *
Flight Date

MonthDayYear
Date
PASSENGER Number 1 Information
Full Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Weight in Pounds*
Maximum per seat is 300 lbs, Aircraft maximum is 500 lbs.
Adult or Child*
An "Infant Passenger Waiver" is required for each Child under "2" years old.
Payment Type*
Agent Notes
Disability or special needs.
Passenger Signature*

Clear
PASSENGER Number 2 Information
Full Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Weight in Pounds*
Maximum per seat is 300 lbs, Aircraft maximum is 500 lbs.
Adult or Child*
An "Infant Passenger Waiver" is required for each Child under "2" years old.
Payment Type*
Agent Notes
Disability or special needs.
Passenger Signature*

Clear
PASSENGER Number 3 Information
Full Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Weight in Pounds*
Maximum per seat is 300 lbs, Aircraft maximum is 500 lbs.
Adult or Child*
An "Infant Passenger Waiver" is required for each Child under "2" years old.
Payment Type*
Agent Notes
Disability or special needs.
Passenger Signature*

Clear
PASSENGER Number 4 Information
Full Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Weight in Pounds*
Maximum per seat is 300 lbs, Aircraft maximum is 500 lbs.
Adult or Child*
An "Infant Passenger Waiver" is required for each Child under "2" years old.
Payment Type*
Agent Notes
Disability or special needs.
Passenger Signature*

Clear
Total Weight
Infant Passenger Waiver

I,   First Name   Last Name   parent, guardian or accompanying adult of the following infant, agree and confirm the child has not yet reached his/her second birthday.

I understand the risks and hazards inherent in the very nature of L R HELICOPTERS INC.’s tours and the risks associated with participating in these tours with my infant child held in a passenger’s arms. I nevertheless freely and voluntarily assume all risks having my infant partake in these tours and agree to be responsible for the infant and to have him/her held securely in a passenger’s arms for the entirety of the flight.

Full name of above-mentioned infant:   First Name   Last Name
Date of Birth:   Date Age:    Add age.

L R HELICOPTERS INC. Policy for Infant & Children Passengers

Child shall be:
- held securely in passenger’s arms*
- properly secured in child car seat**
- properly secured with aircraft safety belt or restraint system***
The appropriate method will vary depending on size & age of child.
The Pilot in Command shall have final say on the best method for the seating arrangements.

* Child must be under 2 year’s (24 Months) of age
** see CAR’s 605.28 below
*** aircraft safety belts or restraint systems must fit child appropriately and not cut into the child’s head or neck.

SIGNED and DATED at   City this   Day Number of   Name of Month, in the year of   Type year here.

Name of Parent or Legal Guardian:   First Name   Last Name

Signature of Parent or Legal Guardian:   Signature

Name of Witness:   First Name   Last Name

Signature of Witness:   Signature

Thank you for your cooperation.
Should be Empty:

PASSENGER MANIFEST

PASSENGER Number 1 Information

PASSENGER Number 2 Information

PASSENGER Number 3 Information

PASSENGER Number 4 Information