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Midwest Balloon Rides - Release and Waiver of Liability, Assumption of Risk and Indemnification Agreement

In consideration of being permitted to participate in any way in hot air ballooning activities conducted by Mayfirst, Inc dba Midwest Balloon Rides and its contractors (hereafter called "Operator"), which include John Derado, Taylon Sandlin, Bernie Sullivan & John Chism.

I UNDERSTAND and AGREE as follows: 

1. My participation may involve being a passenger in a free-floating aircraft controlled by wind and weather conditions at high altitudes; on-ground activities related to hot air ballooning; riding in a chase or other vehicle; or being a passenger in a tethered balloon (hereafter collectively referred to as the "activities"). Participating in the activities is potentially hazardous and could result in my severe injury or death. During my participation in the activities, I will be exposed to numerous risks, including, but not limited to, hard or emergency landings, capsize of basket or other vehicle, collision with obstacles on the ground or in the air, injury from natural or man-made conditions, accident or illness in remote places without medical facilities, negligent rescue operations, immersion in water, hypothermia, acrophobic conditions, incidents related to ascents and descents, injury from other balloons or people, pilot error, equipment failure, falling from the balloon while in the air or on the ground, fire or flame, temperature extremes, or inclement weather conditions or adverse weather-related incidents, trip-and-fall hazards, animal and insect attacks, traffic accidents, loss of or damage to personal property, arrest for trespassing or other violations of the law, and latent risks of any nature. I nevertheless ACCEPT THESE RISKS and wish to participate in the activities. 

2. Although Operator has taken reasonable precautions to provide an air-worthy balloon, equipment and safety preparations for each activity, it is impossible for Operator to guarantee my safety. Also, I understand that I share the responsibility for safety during the activities, and I accept this responsibility. I agree to comply with the instructions and directions of Operator and Operator's personnel before, during and after the flight, while participating as crew, and at all times during the activities. I have no physical or psychological problems ( nor am I pregnant) that would prohibit me from participating in a hot air balloon flight or rough landing. If I perceive anything as dangerous and as a result wish to terminate my participation in the activities, I will notify the Operator immediately. 

3. I hereby release and waive any and all claims for negligence against Operator and their agents, representatives, sponsors, insurers, successors, and assigns (the "releasees") for any injury, loss, or damage I may suffer, that may be in any way related to the activities. I covenant not to sue for such claims. I intend for this release and waiver to be as broad and inclusive as allowed by law and if any portion of this Agreement is held invalid, the remaining portions shall be in full legal force and effect. 

4. I will indemnify and hold harmless the releasees from any loss, liability, damage, or cost they may incur arising out of or related in any manner to my participation in the activities. 

5. Unless otherwise requested by you the passenger, Operator may use pictures and or videos with you on the balloon ride having a great time for advertising and promotional purposes. We will not use your name without additional permission. 

I HAVE READ THIS AGREEMENT AND AGREE TO BE FULLY BOUND BY ALL OF ITS TERMS AND CONDITIONS.

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First Participant's Name
First Name*
Last Name*
First Participant's Date of Birth*
Date of Birth
First Participant's Signature*
Parent or Guardian's Email Address
Email*
Confirm Email*
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Flight Information
Enter your scheduled date: (Example) XX/XX/2013 *
Parent(s) or Court-Appointed Legal Guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name
First Name*
Last Name*
Phone*
Parent or Guardian's Date of Birth*
Date of Birth
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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