Aer
Blarney Balloons
PO Box 1528
Litchfield, CT 06759
(203) 910-4955
Name:__________________________________
Flight Reservation Date:________
Address:___________________________________________________________
Approximate
Weight:__________ Phone: (h)________________ (w)_____________
PASSENGER
STATEMENT OF RESPONSIBILTY
I acknowledge that my participation in a hot air balloon flight
is a potentially hazardous activity. I understand that during
my participation in a hot air balloon flight conducted by
Aer Blarney Balloons, I will be exposed to above-normal risks.
I understand, too, that although Aer Blarney Balloons, has
taken precautions to provide equipment and safety preparations
for each flight, it is impossible for Aer Blarney Balloons
to guarantee absolute safety. Also, I understand that I share
the responsibility for safety in flight and I assume that
responsibility.
I have
accepted responsibility to verify with my physician that I
have no physical or psychological problems that would prohibit
me from participating in a hot air balloon flight and I agree
to comply with the instructions and directions of the “Pilot”
during the entire flight.
I further
understand that, if I cancel my flight less than two weeks
prior to the flight date or do not appear at flight time on
the flight date, I forfeit the deposit amount and the flight.
I also understand that on the morning or afternoon of the
reserved date are to call Aer Blarney Balloons at an agreed
upon time prior to leaving for the launch site.
Date:_______________________
Print Name:_____________________________________
Passengers
Signature:________________________________________________________
ACKNOWLEDGMENT
OF PARENT OR GUARDIAN:
I acknowledge
that there can be no guarantee of absolute safety against
risk and unforeseen accident, as described in this statement,
that ____________________ shares the responsibility for safety
during the flight of the hot air balloon. I consent to the
participation of ____________________ in a hot air balloon
flight with Aer Blarney Balloons.
Date:_______________________
Print Name:_____________________________________
Parent/Guardians
Signature:____________________________________________________
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