Agreement And Release Of Liability Form For Students Campers Form (Page 2 of 2) in pdf

accident/medical insurance company shall pay for ALL such incurred expenses.

My accident/medical insurance company is __________________________ and my policy number is _____________________.

In the event of an accident or injury I authorize THIS STABLE to give and/or arrange for emergency medical treatment as needed.

PROTECTIVE HEAD GEAR OFFERING- I, for myself and on behalf of my child and/or legal ward, have been offered protective

head gear (Equine Safety Helmet) by THIS STABLE and do understand that the wearing of such head gear while mounting,

riding, dismounting and otherwise being around horses, may prevent or, reduce severity of some head injuries, and may even

prevent death as the result of a fall or other occurrence. It is understood that STABLE-PROVIDED protective head gear may not

be a perfect fit for each rider's head, and that once provided I/WE will be responsible for securing the helmet on this riders head at

all times. All riders age 17 and under are required to wear a safety helmet at all times when riding.

[ ] PROTECTIVE HEADGEAR ACCEPTANCE: I/WE REQUEST TO WEAR PROTECTIVE HEAD GEAR WHICH THIS

STABLE PROVIDES.

[ ] SELF-PROVIDED PROTECTIVE HEADGEAR: l/WE WILL PROVIDE MY/OUR OWN PROTECTIVE HEAD GEAR.

EQUIPMENT NEEDS- THIS STABLE requires that all riders be properly fitted for the purpose of riding. Proper dress includes

long pants, hard soled riding boots and an Equine safety helmet. I agree to furnish for myself or minor child the proper equipment

to make riding safer and more comfortable.

LIABILITY RELEASE: In consideration of THIS STABLE allowing my participation in this activity, under the terms set forth herein,

I, the rider, and the parent or legal guardian thereof if a minor, do agree to hold harmless and release THIS STABLE, its owners,

agents, instructors, councilors, staff, farm employees, officers, members, promises owners, insurers, and affiliated organizations

from legal liability so long as I am engaged as a Rider at THIS STABLE. I do further agree that except in the event of gross and

willful negligence, I shall bring no claims, demands, actions and causes of action, and/or litigation, against THIS STABLE and ITS

INSTRUCTORS AND ASSOCIATES as stated above in this clause, for any economic and non economic losses due to bodily

injury, death, property damage, sustained by me and/or my minor child or legal ward in relation to the premises and/or operations

(including off site horse shows) of THIS STABLE, to include while riding, handling, or otherwise being near horses owned by or in

the care, custody and control of THIS STABLE.

NOTICE: A person who is engaged for compensation in the rental of equines or equine equipment or tack or in the instruction of a

person in the riding or driving of an equine or in being a passenger upon an equine is not liable for the injury or death of a person

involved in equine activities resulting from the inherent risk of equine activities.

I/WE HAVE READ FULLY AND UNDERSTAND COMPLETELY THIS AGREEMENT,

WARNINGS, RELEASE AND ASSUMPTION OF RISK.

I/WE FURTHER ATTEST THAT ALL FACTS RELATING TO THE RIDER’S PHYSICAL CONDITION,

EXPERIENCE AND AGE ARE TRUE AND CORRECT.

_____________________________________________________________________________________________________ DATE ___________________

SIGNATURE OF RIDER (If over 18)

_____________________________________________________________________________________________________ DATE ___________________

SIGNATURE OF PARENT or GUARDIAN

RELATIONSHIP TO RIDER

Address:

_________________________________________________________________________

Home Phone # _________________________

______________________________________________________

Cell Phone # __________________________

Email:

__________________________________________________________________________

Emergency # __________________________

Please add me to your email distribution list (Foster Farm will NEVER sell your information)

Agreement And Release Of Liability Form For Students Campers Form Page 2

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