Youth Application Fee

$50.00

Student Full Name(Required)

Date of Birth(Required)

Age(Required)

Grade Level(Required)

School Name

Parent/Guardian Full Name(Required)

Relationship to Student(Required)

Phone(Required)

Email(Required)

Home Address(Required)

Emergency Contact Name(Required)

Phone(Required)

Relationship(Required)

Why is the student interested in aviation?(Required)

Flying / becoming a pilot

STEM / science & engineering

Career Exploration

General interest

Other

If other please explain

Medical & Safety Information(Required)

Yes

Does the student have any medical conditions, allergies, or physical limitations we should be aware of?

Is the student currently under medical care that limits physical activity?(Required)

Yes

Parent Acknowledgment(Required)

I acknowledge and agree

(Parent/Guardian must read and agree) I understand that the Vernekar Pilot School Youth Aviation Program is an educational and exploratory program designed to introduce students to aviation concepts and careers. I acknowledge that: This program is not flight certification or pilot training Participation does not guarantee enrollment in future flight programs Activities may include classroom instruction, simulator use, airport exposure, and supervised aviation-related experiences Any optional flight experience will require separate consent

Liability & Release (Florida-Safe Language)(Required)

I acknowledge and agree

I, the undersigned parent/legal guardian, voluntarily allow my child to participate in the Vernekar Pilot School Youth Aviation Program. I understand that aviation-related educational activities carry inherent risks. I agree to release, indemnify, and hold harmless Vernekar Pilot School, its owners, instructors, staff, and affiliates from liability for ordinary negligence arising from participation, except where prohibited by Florida law.

Photo/Media Consent (Optional but Recommended)

Yes

I grant permission for Vernekar Pilot School to use photographs or videos of my child taken during program activities for educational or promotional purposes.

Code of Conduct(Required)

I agree

I understand that students are expected to: Follow safety instructions at all times Respect instructors, staff, and fellow students Behave responsibly in aviation environments Failure to comply may result in removal from the program.

Upload Parent/Guardian Government Issued ID(Required)

Max. file size: 1 GB.

Parent/Guardian Signature(Required)

Parent/Guardian Full Name

Signature(Required)

Date(Required)

Important Notes Program participation is subject to availability and age eligibility Vernekar Pilot School complies with Florida youth safety and nondiscrimination standards This application does not create a contractual obligation ✅ Why this application is Florida-safe ✔ Parent consent required ✔ Medical disclosure limited and appropriate ✔ Liability language consistent with Florida standards ✔ No promises of certification ✔ No discriminatory language ✔ Youth protection focused

Product Name

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