Hunterdon Ballooning Inc Reservation Request
Please answer each question.
Email address *
First Name *
Last Name *
Address *
City *
State *
Zip *
Main phone (home or cell)
Secondary phone
Emergency Contact Name and Phone *
Gift Certificate?
*Gift certificates and receipts will be mailed to the name and address above. Alternate Mailing Instructions can be included in the Special Instructions section below. Please include complete address and recipient information.
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Gift certificate Number (if redeem above)
Flight Date (First Choice) *
MM
/
DD
/
YYYY
Flight Date (Second Choice)
MM
/
DD
/
YYYY
Best time(s) of day? *
Number of passengers *
Passenger #1 Name, Age, Weight
All three are required
Passenger #2 Name, Age, Weight
All three are required
Passenger #3 Name, Age, Weight
All three are required
Passenger #4 Name, Age, Weight
All three are required
Can everyone on the flight stand for three hours? *
Does any passenger have any medical issues or recent surgeries? *
Can everyone climb into the basket which is at least 3 feet tall? *
Is any passenger in a cast, using a cane, or using any assistance to walk? *
Is any passenger pregnant or have reason to believe they are pregnant? *
Special information we should know:
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