Friday Night Lights Application

FRIDAY NIGHT LIGHTS APPLICATION-

The staff and volunteers of the Mid-South Balloon Festival are dedicated to making Friday Night Lights for children and adults with special needs an exciting and memorable event.

This application must be completed and submitted by 11:59PM CST on August 1, 2025. Space is limited and families will be served on a first come, first serve basis. By submitting this application, it does not guarantee attendance.

Questions on the application are asked for the benefit of your child and so we may provide the best experience and safest environment for everyone involved. Any information shared from this form is communicated directly with those caring for your child and only on a “need to know” basis.

Child's Name*

First NameLast Name

Date of Birth*

Date

My child has the following allergies and/or food sensitivities:*

My child’s allergies can be life threatening*

YesNo

My child's allergies can be life threatening and require the use of an EpiPen*

YesNo

My child is at risk for*

If "Other" please explain

My child has the following diagnosis, medical condition or learning difference:*

My child's main mode of functional communication:*

Gestures & Body LanguagePECSSign LanguageVerbalization

My child:*

is ambulatoryneeds a wheelchairuses a walkerN/A

My child may need assistance with*

Arts & CraftsBounce HouseInflatable Obstacle CourseN/A

My child is uncomfortable with or has an aversion to:*

A trigger-point for resistance, frustration or a behavioral problem may emerge for my child when:*

When/if my child experiences a period of frustration, he/she calms when we:

Parent Name*

First NameLast Name

Cell Phone*

Please enter a valid phone number.

Email*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Emergency Contact *

First NameLast Name

Relation

Cell Phone

Please enter a valid phone number.

Siblings- Names and Ages *

Additional Information

I acknowledge all the information on this intake form is true. I will notify the staff if there is a change in my child’s health which could have an impact at the festival. I as the parent/guardian acknowledge that I will be in attendance and will be responsible for assisting with my child at ALL times.*

YesNo (if selected, this will void the application)

I understand in the event my family and I are unable to attend the event we agree to NOT to give our tickets away.*

AGREE

PLEASE READ THE FOLLOWING CAREFULLY. I acknowledge all the information on this application is true. I will notify the staff if there is a change in my child’s health which could have an impact at the Mid-South Balloon Festival. Hot air ballooning is a dangerous activity. This agreement includes important information and the assumption of risk and waiver of liability related to the Mid-South Balloon Festival and activities for Friday, September 19, 2025 for Friday Night Lights for Special Needs Children and Adults. As the parent or guardian of an individual who has been approved to attend the Friday Night Lights for Special Needs Children and Adults, I acknowledge that I will be in attendance for the event and will be there to support and assist my child at ALL times. I acknowledge that if I, as the parent/guardian, I cannot be there for my child at ALL times, my child will not be allowed in the event. This is for the safety of my child as well as others. ASSUMPTION OF RISK & WAIVER OF LIABILITY(This applies to the person completing the application and all parties listed on the application.) I/We hereby acknowledge I/We have VOLUNTARILY agreed to participate in hot air ballooning activities. I/We understand and I am/We are aware hot air ballooning is a hazardous activity. I/We understand hot air ballooning and the use of ballooning equipment involves risk of injury or death and there is a possibility I/We could be injured or killed while participating in this activity. I/We hereby agree to, and expressly assume the risks of injury or death while I am engaged in hot air ballooning recreational / sporting activities whether during the flight preparation, take-off, tethered ride, landing, pack-up or travel to or from the take-off or landing areas, including ground transportation.I (we), am (are) participating in a tethered hot air balloon ride at Mid-South Balloon Festival at my (our) own risk, which I (we) voluntarily assume. In consideration of being allowed to ride in the hot air balloon and in full recognition of the risks involved with such activity, which risks I (we) voluntarily assume.I acknowledge that per the Federal Aviation Regulations, the pilot of the aircraft is in full and complete charge and control of the balloon and is solely responsible for all decisions made concerning all things or persons in or connected with the balloon on the ground or in the air.I/We hereby irrevocably waive and release my pilot, the Mid-South Balloon Festival, financial sponsors of balloons, festival officials, sponsors of children and/or families, volunteers and owner of property where event occurs, and their respective officers, directors, trustees, agents members, employees, successors, heirs, assigns, affiliates, and legal representatives (Released Parties) from all claims rights, demands or actions for ordinary negligence which I, or my successors, heirs or assigns may have against the Released Parties in connection with the ballooning activities whether caused by the risks inherent in these activities or by the ordinary negligence of the Released Parties or the dangerous condition of any property upon which the ballooning activities may take place.I hereby grant to Mid-South Balloon Festival and its subsidiaries, affiliates, agents, representatives and designees the irrevocable, non-exclusive, non-transferable, royalty-free perpetual right and license to use and display my photo ("Photo") for any and all purposes, including marketing, promotion or advertising, in any and all media channels and social platforms (now known or hereafter existing), without compensation, payment or other consideration of any kind. Mid-South Balloon Festival may use, display, edit, alter, reproduce, create derivative works from, publish or distribute the Photo for any lawful purpose in its sole discretion, with no obligation to me or right of inspection or approval. further grant Mid-South Balloon Festival the right to use my name, username, social media handle and/or likeness as depicted in the Photo (collectively, "Likeness") in connection with Mid-South Balloon Festival use of the Photo. I/We further understand and agree this release extends to all claims for ordinary negligence of every nature or kind whatsoever, known, unknown, suspected or unsuspected, arising out of the ballooning activities.I/We will also follow the protocols, dictated by the Shelby County Health Department, in place at the time of the event including wearing a face mask at all times.I/We hereby agree to and accept the terms and conditions of this Assumption of Risks & Waiver of Liability Agreement. This Assumption of Risks & Waiver of Liability Agreement constitutes the final and entire agreement between the Released Parties and the undersigned (and the individuals included on this application) concerning this subject matter. In the event of litigation with respect to the ballooning activities or this agreement, the prevailing party shall be entitled to recover attorney fees and the costs of litigation.I/We certify that I am eighteen (18) years of age or older and that I have no medical, physical or mental condition that prevents me from participating in the ballooning activities. Please read & select ACCEPT below to indicate understanding: “I have carefully read this Assumption of Risks And Waiver of Liability Agreement and I fully Understand it”. If you do not ACCEPT this Assumption of Risks and Waiver of Liability Agreement, your application will not be accepted.*

Accept