A Yankee Balloon LLC

Express assumption of risk agreement and medical statement

                During the flight and associated travel, preparations, and recovery, certain risks and dangers exists which are inherent in all travel, including balloon flights.  These risks include loss of or damage to personal property, arrest for trespassing or other violations, injury or fatality due to capsize of a 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 reason.                                         Initial_________

                In consideration of, and as part payment for, the right to participate in such trips, flights or other activities arranged by A Yankee Balloon LLC and its agents, associated, sub-contractors, and employees, you will hold A Yankee Balloon LLC harmless from any and all liability, actions, causes of action, debts, claims and demands of every kind and nature whatsoever including, but not limited to, claims arising from a negligence of A Yankee Balloon LLC, its agents or employees which you now have or which may arise out of or in connection with your trip, flight and any other activities arranged for you by A Yankee Balloon LLC.                         Initial_________

                For the landing, you must agree to the following landing procedure, and to obey the Pilot in

Command.  During landing you must stand facing the direction of flight, with feet and knees slightly bent, holding tightly to the inside of the basket.  You may not exit the basket until instructed to do so by the Pilot in Command.                                                                                                                                             Initial_________

                By signing this agreement, you certify you have no physical or mental defect, which prevents you from safely participating in any balloon activities.  The terms hereof shall serve as a release and express assumption of risk for you, your heirs, executors and administrators and all members of your family, including and minors accompanying you.  (Pregnancy is considered a risk).                      Initial_________

                I have read, understand, and agree to the terms of this transaction, assumption of risk agreement and medical statement.  Each adult must sign and parent or guardian must sign for minors.

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Date__________________________________                AM_____  PM_____