UTAH HELICOPTER

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Utah Helicopter Student Enrollment Form

THIS FORM IS REQUIRED TO BE ABLE TO ATTEND UTAH HELICOPTER

How Did You Hear About Us? Rating Desired: PRIVATE
COMMERCIAL
INSTRUMENT
CFI
CFII
ALL

Flight Schedule: (your availability)

Start Date: (MM/DD/YYYY)

Please select which days of the week you are available for training and what time during the day:

Days (check all that apply)		Time of Day (example: 9am-11am)
Mondays
Tuesdays
Wednesdays
Thursdays
Fridays
Saturdays

Name:

Address:
City: State: ZIP:

Home Phone: Cell Phone: Email Address:

Current Weight: Birthdate: (MM/DD/YYYY)

Driver's License State: Driver's License #:

Drug or Alcohol Conviction in the Past 12 Months: YES
NO
Felonies: YES
NO

Ratings Held: Total Helicopter Time:

Certificate Type: Certificate #: Total Flight Time:

Emergency Contact Name: Relationship:

Emergency Contact Address: Emergency Contact Phone: I Give Utah Helicopter Authorization to Administer Medical Treatment YES
NO

UTAH HELICOPTER POLICY AND ACCEPTANCE AGREEMENT

Enrollment Requirements:

U.S. CITIZEN
READ, WRITE, SPEAK AND UNDERSTAND THE ENGLISH LANGUAGE
WEIGHT MAXIMUM 240LBS
HIGH SCHOOL DIPLOMA OR G.E.D.
16 YEARS OF AGE OR OLDER

I Agree to All Policies, Terms, and Conditions Set Forth in the Student Catalog. YES
NO
I Agree to Make Payment in Full to Utah Helicopter Weekly for the Time I Am Billed. YES
NO
I Agree to Attend the Robinson Factory Safety Course Prior to Carrying Any Passengers. YES
NO
I Agree to Pay 2 Hours of Ground Instruction for Cancellations Less Than 24 Hours in Advance. YES
NO
I Agree to Pay $250.00 Per Day for Absences Not to Exceed 5 Days Or $1250.00. YES
NO
I Agree to Cancel Lessons for Absences of More Than 1 Day, 5 Days Prior to the First Day Off. YES
NO
I Agree to Pay a $25 Non-Refundable Enrollment Fee. YES
NO
If I choose to discontinue lessons prior to my ratings being complete I agree to pay a $250 processing fee. YES
NO
I Have Read, Understand and Agree to Abide by the Terms Set Forth in This Enrollment Agreement. YES
NO, cancel the form
Date: 02/06/2012

UTAH HELICOPTER

Questions about this form?Please contact us.

Utah Helicopter Student Enrollment Form

Flight Schedule: (your availability)

UTAH HELICOPTER POLICY AND ACCEPTANCE AGREEMENT

Questions about this form?
Please contact us.