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ACKNOWLEDGEMENT
of RISK and RELEASE of LIABILITY – “For Participants Not 18 Years
Old”
Please
Print Clearly
Infant
Participant’s Name:_____________________________________________
Date of Birth:__________________
Infant’s
Address: _____________________________________City: _______________Prov: ____Postal:_________
Guardian’s
Name: __________________________________________________Date of
Birth:__________________
Guardian’s
Address:___________________________________
City: ______________Prov: ____Postal__________
The Guardian must
Read and Understand prior to the Infant Participating in Equine
Activities
TO:
DREAMFIELDS RIDING CENTRE
, their directors, employees, officers, volunteers, business
operators, officers, 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 am
the Parent and/or Legal Guardian of the Infant Participant named
above and am executing this form on behalf of the infant Participant
in my capacity as parent and/or guardian and with the intent that
this form be binding on the myself and infant Participant for all
legal purposes.
____ 2) 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.
____ 3) I
Acknowledge that the inherent “RISKS” of Equine Activity
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 movements, 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 the infant
being a Participant.
___ 5) I
Acknowledge that it remains my Sole Responsibility for
the safety of the infant Participant and for the infant to
Participate within his/her own limits.
____6) In
addition to consideration given for the infant to Participate in
Equine Activity, I and my heirs, executors, administrators and
assigns (collectively called my “Legal Representatives)” agree:
·
To Waive All
Claims that I or the infant Participant might have against the
“HOST”;
and
·
To Release the
“HOST” from Any and All Liability
for any loss,
damages, injury, or expense that I, the infant Participant or our
“”legal Representatives” might suffer as a result of the infant’s
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 the infant
Participant or to any third party which might result from the
infant’s Participation.
Before
signing this form I read it (as indicated by my initials above) and
I state that I understand it. I Further state I am aware that
signing this form, waives certain legal rights I and/or the infant
Participant and/or our “Legal Representatives” might have against
the “HOST”.
SIGNED This
___________________day of __________________________________, 20___
Do NOT SIGN
until you Understand All Items Above
Signature of
Parent/Guardian____________________________________________________
Signature of
Participant____________________________________________________
Print Name of Witness to Signing & Initialing _________________________
Signature of
Witness_____________________________
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