Notice: By signing this agreement, you are
forever releasing and waiving your rights to make a claim for injuries or
damages against Andre Boucher and A& a Balloon Rides, LLC. Read this
document carefully before signing.
1) I acknowledge that I have voluntarily applied to
participate in Hot Air Balloon flights and associated activities to be
conducted by; Andre Boucher and A& a Balloon Rides, LLC.
2) I am aware that a Hot Air Balloon
flight is a potentially hazardous activity. Some of the risks include, but are
not limited to, loss of or damage to personal property, arrest for trespassing
or other violations of the law, serious bodily injury or fatality due to
capsize of basket, or other vehicle, collision with obstacles on the ground or
in the air, accident or illness in remote places without medical facilities,
immersion in water, and hypothermia, falling from a balloon while in the air or
on the ground, fire or flame and temperature extremes or inclement weather. I
am voluntarily participating in these activities with knowledge of the danger
involved, and I hereby agree to accept and assume any and all risks of injury
or death.
3) As a passenger, I agree to help
make the flight safer by pointing out any potential hazards such as power lines
or other Balloons in the immediate vicinity. I also agree to follow the pilot’s
instructions throughout the duration of the flight.
4) By signing this agreement, I
certify that I have no physical or mental condition that prevents me from
participating in any Balloon activities.
5) In consideration for being
permitted by Andre Boucher and A& a Balloon Rides, LLC herein referred to
as A& a Balloon Rides, LLC, to participate in these activities and use of
their facilities, I hereby agree that I, my assignees, heirs, distributees,
guardians, and legal representatives will not make any claim against, sue, or
attach the property of A& a Balloon Rides, LLC, its agents, employees, and
contractors for any injury or damage resulting from the negligence or other
acts, howsoever caused, by any employee, agent or contractor or A& a
Balloon Rides, LLC, as a result in my participation in Hot Air Balloon flights
and associated activities. I hereby release A& a Balloon Rides, LLC, its
agents, servants, and employees, from all actions, claims, demands, that I, my
assignees, heirs, distributes, guardian, and legal representative now have or
may hereafter have for injury or damage resulting from my participation in Hot
Air Balloon flights and associated activities. Further , I agree to indemnify
and hold harmless A& a Balloon Rides, LLC and its agents, servants, and
employees against any claim for injury or damages that I may sustain as a
result of my participation in any of the activities of A& a Balloon Rides,
LLC.
6)
I have carefully
read this agreement and fully understand its contents. I am aware that this is
a release of liability and a contract between myself and A& a Balloon
Rides, LLC, and sign it of my own free will.
Date:___________________________________.
X__________________________________
, _________________________________________.
Passenger Signature Print Name Clearly
(Parent/Guardian of
Passenger) ____________________ ___
Witnessed by:
__________________________________________________________________________.