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Light Flight Balloons, Inc.

Assumption of Responsibility and Risk Agreement, Release, Waiver, & Medical Statement

 

    I understand that ballooning and balloon flight, in all its various stages and aspects is inherently more dangerous than the activities of daily living and a potentially hazardous activity that subjects the participants (including ground crew and spectators) to risks of property damage or loss, arrest for trespassing, physical injury, and  death. I recognize the danger and voluntarily accept the aforementioned risks from any and all causes, including, but not limited to: other aircraft, latent defects in the aircraft or its equipment, hard or rough landings, contact or collision with obstructions and obstacles such as trees, fences, buildings, towers, poles, and wires, the conditions of weather to include, but not limited to: winds, temperature extremes, inclement weather, immersion in water and hypothermia, slips and falls while aboard the aircraft or on the ground, fire and flame, accident, illness, and any other foreseen and unforeseen, known and unknown risks, and or events. I understand and voluntarily accept that the nature of balloon flight and retrieval will put me in remote places and upon property that may not be in a safe condition, without medical or other facilities and may present an inability or failure to meet schedules or provide the length of advertised flight time in order to safely conduct the flight. I further assume the risk of any illness, malady or other medical condition resulting from air travel and balloon flight and represent that I am in good general health and have no current medical condition, pre-existing injury or condition, or other physical or mental condition that may or might be exacerbated by balloon flight.

 

    I acknowledge that the pilot of the aircraft has all the command prerogatives of any captain of an FAA commercial aircraft and that his/her commands will be obeyed and carried out to the fullest of my ability; especially landing instructions, of which I have been informed and are reiterated here, wherein I must stow all personal belongings, hold firmly to rope handles or uprights, brace with feet and knees together, bend knees slightly, tense muscles to absorb landing shock as though I were jumping from a height and from a moving object, while facing the direction that the Pilot advises. I will keep my arms and legs inside the basket and not exit the basket until instructed to do so by the Pilot.

 

    In return for my participation and with the intent to bind myself, my spouse, parents, children, legal representatives, heirs, executors, administrators, lien holders, successors, and assigns, I hereby irrevocably and unconditionally, agree to forever release, indemnify, acquit, hold harmless, and forever discharge Light Flight Balloons, Inc., its agents, employees, associates, volunteers, sub-contractors, Michael Gerred, the pilots, crew, launch and landing site property owners and its/their/his heirs, executors, administrators, successors, and assigns ["Released Parties"], of and from all debts, demands, claims, actions, rights, costs, loss of service, expenses (including attorneys’ fees) and compensation whatsoever, liabilities, losses, damages, actions, or cause of action of every kind and nature whatsoever including, but not limited to, claims arising from the active, passive, or ordinary negligence of Light Flight Balloons, Inc., its agents, employees, associates, volunteers, and sub-contractors which in any manner may arise out of or in connection with my ballooning activities. I further grant permission to Light Flight Balloons, Inc. to use my name and photographic likeness in all forms and media for advertising, trade, and any other lawful purposes without compensation. I understand that the balance of my account is due and payable at the conclusion of the flight and that it is my responsibility, as the recipient of the service, to make such payment, regardless of who made the original purchase or paid the deposit. I further agree to the charging and payment of simple interest at the rate of eighteen percent (18%) per annum, and one and one-half percent (1.5%) periodic rate for all balances over thirty (30) days. If the company must refer my account to an attorney for collection, I shall pay on demand all court costs and expenses of collection including actual attorney’s fees incurred by the company, whether or not any lawsuit is filed. I waive the issuance and service of process and confess a judgment in favor to the company for the amount of the bill, plus interest, together with the cost of the suit thereon including the aforesaid attorney’s fees.

 

I understand that this Assumption of Responsibility and Risk Agreement, Release, Waiver, and Medical Statement is intended to be as broad and as inclusive as permitted by the laws of the State of Maryland. I agree that if any portion of this document is held to be invalid, the remainder shall continue in full legal force and effect, and that it contains the entire agreement between the Released Parties and the undersigned and that its terms are contractual and not a mere recital. I have read the foregoing and fully understand its meaning and significance, having been given the opportunity to discuss it with anyone of my choosing prior to its execution.

IN WITNESS WHEREOF, and intending to be legally bound hereby, I set my hand and seal on this

_______ Day of                                       , ______, and hereby acknowledge, understand, and agree to the above.

 

1. ___________________________________________________   _________________________________________________

       Passengers Printed Name/Parent/Legal Guardian Printed Name                                      Signature

 

2.____________________________________________________   _________________________________________________

 

3. ____________________________________________________   _________________________________________________

 

4._____________________________________________________   _________________________________________________

 

5._____________________________________________________   _________________________________________________

 

6._____________________________________________________   _________________________________________________

 

7._____________________________________________________   _________________________________________________

 

8._____________________________________________________   _________________________________________________

 

9______________________________________________________   _________________________________________________

 

10.____________________________________________________   __________________________________________________”

                                     Printed Name                                                                                      Signature           Hold Harmless Rev. 06/09

 

Note: The signing of this form is an insurance requirement for all passengers. It will be presented for your signature at the time of flight. If passengers are under the age of 18, the form must be signed by a parent or legal guardian present at the time of flight. Please read the form prior to your flight.

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