Safety Equipment Acknowledgment And Release Form
Download a blank fillable Safety Equipment Acknowledgment And Release Form in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Safety Equipment Acknowledgment And Release Form with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2SAFETY EQUIPMENT ACKNOWLEDGMENT AND RELEASE FORM
For Participants Over the Age of Majority
(
)
Please Print Clearly
Participant's Name:___________________________________________ Date of Birth:_______________
Address:_____________________________________ City________________ Prov.____ Postal_______
No person riding without a helmet designed for equine activities will be allowed to participate
in equine activities prior to reading and signing this form.
TO:_________________________________________________________________________________,
their directors, employees, (Name of Person, Organization or Company providing the Equine Activities)
officers, volunteers, business operators, and site property owners, (all of them collectively called the HOST):
ACKNOWLEDGMENTS AND STATEMENTS OF PARTICIPANT
Initial each item below After Reading and Understanding the item.
_____ 1) I Understand the RISKS inherent in equine activities as evidenced by the separately signed
Acknowledgment of Risk and Release of Liability Form on file with the "Host".
_____ 2) I Understand wearing proper safety equipment may reduce injury even though no amount of
preplanning can remove all the DANGERS, HAZARDS, and RISKS of equine activities.
_____ 3) I have Freely Decided to ride without wearing a helmet designed for equine activities which
might prevent permanent brain damage in the event of an accident.
_____ 4) I have Refused Critical Safety Equipment for equine activities against the advice of the "Host".
_____ 5) I Fully Assume all additional DANGERS, HAZARDS, and RISKS to which my decision to
ride without a helmet might expose me.
_____ 6) I Understand that signing this form Waives certain Legal Rights I might have against
the “Host”.
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____
_______________________________________
(Signature of Participant)
Do Not Sign until you Understand All Items Above
________________________________________
______________________________________
(Print HOST Name Witness to Signing & Initialing)
(Signature of HOST Witness)
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal