Please Print Clearly
Participant's Name: ___________________________________________ Date of Birth: __________________
Address: ___________________________________ City: __________ Prov: _______ Postal: ____________
Every person must Read and Understand this form before Participating in Equine Activities
TO: ______________________________________________________,
their directors, employees, officers,
(Name of Person, Organization or Company providing
the Equine Activities)
volunteers, business operators, and site property owners. (all of them
collectively called the HOST)
Initial each item below After Reading and Understanding the item
| _____ | (1) |
I Understand there are Inherent DANGERS, HAZARDS and RISKS (collectively called RISKS) associated with Equine Activities and injuries resulting from these "RISKS" are a common occurrence. |
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| _____ | (2) |
I Acknowledge that the inherent "RISKS" of Equine Activities mean those DANGEROUS conditions which are an integral part of Equine Activities, including but not limited to: |
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The propensity of any equine to behave in ways that might result in injury, harm or death to persons on or around them and to potentially collide with, bite or kick other animals, people or objects; |
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The unpredictability of an equine’s reaction to such things as sounds, sudden movement, tremors, vibrations, unfamiliar objects, persons or other animals and hazards such as subsurface objects. |
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The potential for other participant(s) to act in a negligent manner that might contribute to injury to themselves or others, such as failing to act within their ability or to maintain control over an equine. |
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| _____ | (3) |
I Freely Accept and Fully Assume All Responsibility for inherent "RISKS" and possibilities of personal injury, death, property damage or loss resulting from my Participation in Equine Activities. |
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| _____ | (4) |
I Acknowledge that it remains my Sole Responsibility to act in such a manner as to be responsible for my own safety and to Participate Within My Own Limits. |
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| _____ | (5) |
In addition to consideration given for my Participation in Equine Activities. I and my heirs, executors, administrators and assigns, (collectively called my "Legal Representatives") agree: |
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To Waive All Claims that I might have against the "HOSTS"; and |
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To Release the "HOSTS" from Any and All Liability for any loss, damages, injury, or expenses that I, or my "Legal Representatives" might suffer as a result of my Participation due to any cause whatsoever including any NEGLIGENCE ON THE PART OF THE "HOST", and |
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TO HOLD HARMLESS AND INDEMNIFY the "HOST" from any and all liability for property damage or personal injury any third party which might result from my participation in Equine Activities.. |
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Before signing this form I read it (as indicated by my initials) and I state I understand it. I know that signing this form, waives certain legal rights I or my "Legal Representatives" might have against the "HOST" |
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SIGNED This __________________________ day of ___________________ 20 _____ |
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_______________________________________ |
_________________________________________________ |
(Print Name of Host Witness to Signing & Initialing) |
(Signature of Participant) |
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DO NOT SIGN UNTIL YOU UNDERSTAND ALL ITEMS ABOVE |
_______________________________________ |
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(Signature of Host Witness) |