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Pagosa Adventure HOT AIR BALLOON

Agreement to participate and waiver of responsibility

  1. As a condition of acceptance, I certify that I am aware that the hot-air balloon flight or tethered fight that I am participating in under the arrangement and/or services of PAGOSA ADVENTURE pilots, associates, agents, contractors, volunteers, officers, or employees (known here forth as Pagosa Adventure) contains certain risks and dangers are present.
  2. These include but are not limited to, injury or fatality due to capsize of basket, collision with obstacles on the ground or in the air, falling while getting in or out of the basket, falling while in the basket, fire, the hazards of accident or illness (including but not limited to strains, sprains, fractures, paralysis, or any other disabling bodily injury or illness) in remote areas without medical personnel or facilities, loss or damage of personal property, arrest for trespassing or other violations, the forces of nature, or other unforeseeable causes, and travel by hot air balloon, automobile, bus, van or any other conveyance.
  3. I understand and assume all risks that may occur during my participation in any activities and/or use of any equipment. I will forever hold harmless, indemnify, and defend Pagosa Adventure for actions, causes of action, claims, judgments, debts, costs (including attorney’s fees), losses from bodily injury, property damage, loss of services, wrongful death and demands of every kind which may arise from or in connection with my hot-air balloon activity, including launch or landing, use of equipment or participation in any other activities arranged for me by Pagosa Adventure.
  4. I will not hold Pagosa Adventure responsible for any losses and/or damages whether caused in whole or in part by negligent acts or omissions, intentional or reckless misconduct, or gross negligence of damages or losses caused by that individual to any vendor or supplier of service’s property. The participant will also be responsible for any additional personal expenses incurred for goods or services not included in activity pricing.
  5. I agree that Pagosa Adventure reserves the right to modify any flight or activity as needed, determine group participation size, mix parties to complete group, and/or change or switch participation areas in any manner without recourse.
  6. Pagosa Adventure reserves the right to refuse transportation, services and/or participation to persons under the influence of intoxicating agents. Or whose conduct is unsafe or is objectionable in attitude or action to other persons. Any and all activities may be stopped, and the individual may be left behind if these actions occur. These individuals will not be eligible for a refund or reimbursement of any kind. Pagosa Adventure will not be held responsible for the conduct of others that may or may not be participating in the hot-air balloon flight or in the area where the flight may take place. I understand and agree to all refund and payment policies for this trip.
  7. Each trip member is hereby permitted and agrees to permit any other member or members the right to photographic or film records of this trip or activity without recourse.
  8. I understand that the hot-air balloon flight that is being conducted solely by Pagosa Adventure and not by any or all sponsor(s) whose name may or may not appear on any portion of the balloon equipment or vehicles used during my participation in the activity. I will forever hold harmless, and indemnify any sponsors, the officers, employees, directors, shareholders, partners, owners, or agents, from any claims or liability in connection with the hot-air balloon flight.

*** The term of this form serves as a release and assumption of risk for my heirs, executors, administrators, legal representatives, and for all members of my family, including any minors who may or may not be accompanying me. I have carefully read and understand the above agreement to participate and waiver of responsibility. I certify that I am healthy and do not have any health concerns that would prevent me from safely participating in a hot-air balloon flight or tethered flight/ride. I understand that I have given up substantial rights by signing this document in its entirety and sign it voluntarily.

PERSONAL INFORMATION

Personal information must be present to be considered for acceptance for participation. Information provided is kept strictly confidential and is considered critical for the safety of all flights or tethered flights. Having your accurate weight is VITAL to the flight, please carefully fill out each section.

Today's Date: December 8, 2022 

First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information

Height *

Weight *

Do you have any allergies and/or health restrictions and/or are you taking any medications? (Explain)

Have you had any illness or surgery that may cause problems during the excursion? (Explain)
Are you pregnant?*
No
Yes
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

Last Name*
Second Participant's Date of Birth*
Second Participant's Information

Height *

Weight *

Do you have any allergies and/or health restrictions and/or are you taking any medications? (Explain)

Have you had any illness or surgery that may cause problems during the excursion? (Explain)
Are you pregnant?*
No
Yes
Third Participant's Name

First Name*

Middle Name

Last Name*
Third Participant's Date of Birth*
Third Participant's Information

Height *

Weight *

Do you have any allergies and/or health restrictions and/or are you taking any medications? (Explain)

Have you had any illness or surgery that may cause problems during the excursion? (Explain)
Are you pregnant?*
No
Yes
Fourth Participant's Name

First Name*

Middle Name

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information

Height *

Weight *

Do you have any allergies and/or health restrictions and/or are you taking any medications? (Explain)

Have you had any illness or surgery that may cause problems during the excursion? (Explain)
Are you pregnant?*
No
Yes
Fifth Participant's Name

First Name*

Middle Name

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information

Height *

Weight *

Do you have any allergies and/or health restrictions and/or are you taking any medications? (Explain)

Have you had any illness or surgery that may cause problems during the excursion? (Explain)
Are you pregnant?*
No
Yes
Sixth Participant's Name

First Name*

Middle Name

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information

Height *

Weight *

Do you have any allergies and/or health restrictions and/or are you taking any medications? (Explain)

Have you had any illness or surgery that may cause problems during the excursion? (Explain)
Are you pregnant?*
No
Yes
Seventh Participant's Name

First Name*

Middle Name

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information

Height *

Weight *

Do you have any allergies and/or health restrictions and/or are you taking any medications? (Explain)

Have you had any illness or surgery that may cause problems during the excursion? (Explain)
Are you pregnant?*
No
Yes
Eighth Participant's Name

First Name*

Middle Name

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information

Height *

Weight *

Do you have any allergies and/or health restrictions and/or are you taking any medications? (Explain)

Have you had any illness or surgery that may cause problems during the excursion? (Explain)
Are you pregnant?*
No
Yes
Ninth Participant's Name

First Name*

Middle Name

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information

Height *

Weight *

Do you have any allergies and/or health restrictions and/or are you taking any medications? (Explain)

Have you had any illness or surgery that may cause problems during the excursion? (Explain)
Are you pregnant?*
No
Yes
Tenth Participant's Name

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information

Height *

Weight *

Do you have any allergies and/or health restrictions and/or are you taking any medications? (Explain)

Have you had any illness or surgery that may cause problems during the excursion? (Explain)
Are you pregnant?*
No
Yes
Participant's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
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*

Middle Name

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

Height *

Weight *

Do you have any allergies and/or health restrictions and/or are you taking any medications? (Explain)

Have you had any illness or surgery that may cause problems during the excursion? (Explain)
Are you pregnant?*
No
Yes
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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