Camp Activity Release

Balloons Over Bloomington LLC

INFORMED CONSENT AND WAIVER FROM LIABILITY AND INDEMNIFICATION AGREEMENT

I (hereinafter referred to as the “Undersigned”) do hereby consent to participate in balloon trips, flights and/or other activities conducted by Balloons Over Bloomington, LLC (hereinafter referred to as “BOB” and the “Company”) that may include but not be limited to: balloon preparation, flight, landing, and other related activities associated with travel, preparations, and recovery (collectively hereinafter referred to as the “Balloon Activities”). I have been informed and am fully aware of the risks and dangers that have been associated with the Balloon Activities including, without limitation, loss or damage to personal property, arrest for trespassing, or other violations, 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 while aboard the balloon in the air or on the ground, fire or flame, temperature extremes or inclement weather, and failure to meet schedules or length of flight time due to weather, recovery problems or any other causes that may arise during the Balloon Activities and understand that my participation is voluntary and further understand the significance of this legal document.

1) I certify and represent that I am physically able to participate in Balloon Activities and I am completely responsible for obtaining any medical advice or medical examination necessary, in my own personal judgment, to ensure that the Balloon Activities I choose are appropriate for my physical condition at all relevant times.

2) I hereby assume all risks associated with my voluntary participation in the Balloon Activities and in enrolling in the Balloon Activities with BOB and I understand that my participation with the Balloon Activities is voluntary and chosen by me. I may discontinue my participation so long as the Pilot-in-Command determines it is safe to do so.

3) I agree that I will not engage in activities that may pose a danger to myself or others and that I will further abide by all instructions given by BOB or by BOB’s representatives, including but not limited to the Pilot-in-Command. I understand that if I do not follow the instructions or create or worsen a situation that, in the sole discretion of BOB, poses disruption or potential harm, I may be removed from the Balloon Activities when it is safe to do so.

4) In consideration of my participation in the Balloon Activities with BOB, I hereby and on behalf of myself, my executors, administrators, heirs, successors and assigns, WAIVE, RELEASE, AND FULLY AND WHOLLY DISCHARGE BOB, its owners, officers, directors, agents, employees, pilots, instructors, and representatives (“Released Parties”), from any and all liability, including but not limited to any obligations, penalties, claims, judgment, demands, actions, suits, losses, damages, costs and expense (including attorney fees) that may arise on account of or from my participation in the Balloon Activities, including liability arising from the negligence or fault of the Released Parties which result in my death, disability, personal injury, property damage, theft or action of any kind which may hereafter occur to or involve me in any manner.

5) I agree that I will indemnify, defend and hold the Released Parties harmless from any and all claims arising out of, or in connection with, any breach by me of the terms of this document; my participation in the Balloon Activities; presence and use on Company property/equipment, and including, but not limited to claims allegedly resulting in whole or in part by negligent acts or omission of the Company (its agents), or for acts or omissions for which the Company otherwise would be strictly liable, which indemnification shall include all damages and reasonable attorney fees.

6) I authorize BOB and its designated representative to consent, on my behalf, to any emergency medical/hospital care or treatment if I am unable to express make a decision regarding the same. I agree to be responsible for all charges incurred by any hospitalization or treatment rendered pursuant to this authorization. I acknowledge medical coverage is not provided or paid for by BOB. I also consent to emergency rescue efforts in the event of an accident or any occurrence with the Balloon Activity.

7) I grant permission to the Company to use my photograph recordings or any other record of my participation in Balloon Activities or events.