Waiver to Print - Fill in completely and initial all spaces. ACKNOWLEDGMENT of RISK and RELEASE of LIABILITY “For Participants 18 Years Old” - Please Participant’s Name:
Email : Date of Birth: Address: Phone Contact:
The Participant must Read and Understand prior to participating in Equine Activities
TO: Corner Stone Farm Equestrian Centre, Catherine Colwell and Joseph McAllister, Short Course Eventing, their directors, employees, officers,
(Name of Person, Organization or Company providing the Equine Activities), volunteers, business operators, and site property owners (collectively called the HOST).
Initial each item below after reading and understanding the item.
____1. I am the Participant named above and am executing this form with the intent that this form be binding on myself for all legal purposes.
____2. I understand there are inherent DANGERS, HAZARDS and RISKS, (collectively called RISKS) associated with Equine Activities and that injuries resulting from these "RISKS "DANGERS, HAZARDS and RISKS are a common occurrence.
____3. I understand that the inherent "RISKS" of Equine Activities mean those DANGEROUS conditions which are an integral part of Equine Activities, including but not limited to:
• 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.
• 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.
• 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.
____4. I freely accept and fully assume all responsibility for the inherent "RISKS" and the possibility of personal injury, death, property damage or loss which might result from being a Participant.
____5. I acknowledge that ensuring my safety and participation within my own limits remains my sole responsibility.
____6. In addition to consideration given to participate in Equine Activities, I and my heirs, executors, administrators and assigns (collectively called my "Legal Representatives") agree:
• To waive all claims that I might have against the "Host"; and
• To release the "HOST" from any and all liability for any loss, damages, injury, or expense that I or my "Legal Representatives" might suffer as a result of my participation due to any cause, including any NEGLIGENCE ON THE PART OF THE "HOST"; and
• To HOLD HARMLESS AND INDEMNIFY THE "HOST" from any and all liability for property damage or personal injury to myself or to any third party which might result from my participationBefore signing this form I read it (as indicated by my initials above) and I stated that I understand it. I further state I am aware that signing this form waives certain legal rights I and/or my “Legal Representatives” might have against the “HOST”. SIGNED This ________ day of_________________ 2013.
Catherine Colwell and Joseph McAllister (Host) and
(Signature of Participant) ___________________________________
(Signature Host Witness) ___________________________________
Do Not Sign until you understand all items above. Please note any medical conditions of which our instructors and helpers may need to be aware. ______________________________________________There are no health issues _______ ( initial if no)