Fillable Flying Permit Application Form - Boy Scouts Of America (Page 2 of 3) in pdf

Aircraft/Balloon

Owner(s): _______________________________________________ Date of last annual inspection: ________________________

Make and model: _________________________________________ Number: __________________________________________

Standard airworthiness certificate category (normal/utility/etc.): ________________________________________________________

Note: Only aircraft with standard airworthiness certificates may be used for orientation flights. Restricted, limited, light sport, and

experimental category airworthiness certificates are not authorized.

Reproduce this page as needed for additional aircraft/pilots.

Insurance

All aircraft owners must have at least $1 million aircraft liability coverage, including passenger liability with sublimits of no less than

$100,000. List all insurance policies that in combination satisfy the insurance requirement.

Insurance company: __________________________________________________________________________________________

Amount: $____________________ Policy number: ____________________

Expiration date: _____________________

Insurance company: __________________________________________________________________________________________

Amount: $____________________ Policy number: ____________________

Expiration date: _____________________

Experimental Aircraft Association (EAA) Young Eagle Flights (ages 8–17): For those EAA members who choose to insure at $100,000

per passenger seat, the EAA automatically provides an additional $1 million liability umbrella policy with sublimits of no less than

$100,000. This coverage is in effect only while participating in Young Eagle Flights. The EAA’s insurance telephone number is

800-236-4800, ext. 6106.

EAA member number: ____ ____ ____ ____ ____ ____. We strongly recommend that all orientation flights be conducted in

collaboration with local EAA chapter Young Eagle Flights. To find a local chapter, visit

Pilot-In-Command

Name: ________________________________________________________________________________________ Age: ________

Address: ___________________________________________________________________________________________________

___________________________________________________________________________________________________

City: ______________________________ State: __________________________ Zip code: ______________________________

Phone: ___________________________________________________ Email: __________________________________________

Type of pilot certificate: _______________ (Attach a copy of current pilot certificate. Balloon pilots must hold a commercial certification.)

Ratings: ____________________________________________________________________________________________________

Pilot medical certificate: o First o Second o Third class (Attach a copy of current medical certificate. Applicable to ALL flights.)

Medical valid until: _______________________ (date)

Limitations: _________________________________________________________________________________________________

Pilot’s total number of flight hours: ________ (250 hours minimum for basic orientation flights; 500 hours minimum for advanced

orientation flights)

Balloon pilot’s total number of flight hours: _______ (100 hours minimum)

680-672

Rev. 2/2012

Flying Permit Application Form - Boy Scouts Of America Page 2