Table Mountain Ranch, Inc.
This form must be filled out for and by persons involved in Equestrian Activities at Table Mountain Ranch, Inc. (AKA TMR) prior to beginning of such activities.
This form must be filled out by an adult. Please choose the option that describes you.
I am an adult (18 or older) filling out and signing for myself. Limit one form per adult.
I am the parent and/or LEGAL GUARDIAN of the minor child/children listed below.
Adult's Contact Information
Street Address Line 2
State / Province
Postal / Zip Code
Antigua and Barbuda
Bosnia and Herzegovina
Central African Republic
Cocos (Keeling) Islands
Democratic Republic of the Congo
Turkish Republic of Northern Cyprus
Papua New Guinea
Republic of the Congo
Saint Kitts and Nevis
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Sao Tome and Principe
Trinidad and Tobago
Tristan da Cunha
Turks and Caicos Islands
United Arab Emirates
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Emergency Contact Name
First & Last
Emergency Contact Name:
Emergency Contact Phone Number:
Choose the options which best describe you.
I am a boarder
I am a student with a trainer
I am leasing a horse boarded at TMR
I am here to look at a horse for purchase
I am hauling in to ride at TMR
I am here for a show or clinic
I am visiting TMR with a boarder/lessor or student
Name of person you are visiting
Name of horse you are leasing
Name of horse you are interested in purchasing.
I am in training and/or lesson with
Whitney Jameson McCarthy
None of the above
Minor Children's Information
I am the parent/legal guardian for the following minor children involved in equestrian activities at TMR. CHILDREN 17 & UNDER MUST WEAR A PROPERLY FITTED ASTM/SEI APPROVED HELMET. No one under 18 years of age may jump a horse without the supervision of an approved jumping instructor, or parental supervision approved in writing by management prior to the commencement of any said activities.
General Liability Waiver & Agreement
You must be 18 or older at time of signing.
INHERENT RISK LIABILITY WAIVER
I recognize that there is a significant element of risk in horseback riding, equine and any other outdoor activity including serious bodily injury or death. In consideration of being permitted to access and use of the facilities and grounds known as Table Mountain Ranch, Inc., for any purpose including, but not limited to, boarding, lessons (for myself or any family members), attending horse shows, participating in any activities, involving equines or otherwise at Table Mountain Ranch (collectively, “Barn Activities”), I acknowledge, appreciate, and agree that I, my heirs, successors, and assigns, do hereby fully and forever release and discharge the said Table Mountain Ranch, Inc. expressively, its owners, officials, officers, directors, agents, and employees, (hereafter collectively known as Management) from any and all claims and demands, actions and causes of action, damages, cost, loss of services and expenses. Also, any and all claims of damages whatsoever, whether arising from negligence or not on account of, or in any way resulting from personal injuries, conscious suffering, death, or property damage sustained by me, arising out of my participation in any recreational activities associated with Table Mountain Ranch, Inc. including without limitation, any such injuries or death resulting from the hazards of traveling in mountainous terrain, accidents, or illness in remote places without medical facilities, unpredictable reactions of animals (which may occur regardless of previous behavior or training due to instinct, fright, or other reasons), the forces of nature, creeks, bridges, traveled roads, wild or domestic animals, stumps, forest growth, debris, rocks, cliffs, and other obstacles, whether they are obvious or not obvious, man-made or natural. In consideration of the foregoing premises, I hereby expressively stipulate, covenant and agree to hold forever harmless Table Mountain Ranch, Inc. and the said Management from any and all other claims or losses and any and all claims from damages whatsoever which may hereafter arise from my negligence, willful or wanton or intentional acts or actions, or failure to act. I understand the potential dangers that I could incur in mounting, dismounting, riding, leading, grooming or any other interaction with said horse. These potential dangers may apply to any horse, regardless of age, size, level of training, disposition or ownership.
ACKNOWLEDGEMENT OF POSSIBLE EXPOSURE TO COVID-19 AND/OR OTHER DISEASE
I further recognize that the participation in one or more Barn Activities by myself, my family members and/or any guests who accompany me (collectively the “Permitted Parties”), may (i) result in my exposure to the COVID 19 virus and/or any other infectious virus or bacterial infection (collectively, the “Disease”) through direct and/or indirect contact or exposure to other persons permitted access to Table Mountain Ranch or (ii) in the event of an accident or other event that may necessitate medical attention to me or any of the Permitted Parties (either in a hospital or other medical setting) may result in my exposure to the Disease as a result of such necessary medical attention. Notwithstanding anything to the contrary contained herein, and to the full extent allowed by applicable statutes and regulations, I on behalf of myself and any of the Permitted Parties, and our respective heirs, successors, and assigns, do hereby expressively stipulate, covenant and agree to hold forever harmless Table Mountain Ranch, Inc. and the said Management from any and all claims or losses or any and all claims from damages whatsoever, including, but not limited to, any and all claims for medical expenses, any resulting disabilities or ongoing medical conditions, and/or death, which may hereafter arise from any and all exposure to the Disease as a result of the participation in any Barn Activities. I hereby expressly acknowledge that I am aware of and understand the potential dangers that could result from any exposure to the Disease resulting from the participation in Barn Activities by myself and or any of the Permitted Parties.
AGREEMENT TO COMPLY WITH BARN RULES AND REGULATIONS
I further acknowledge and agree that I will comply with the rules and regulations which have been established by Table Mountain Ranch, Inc. for participation in Barn Activities, including, but not limited to, any rules and regulations relating to safe practices for exposure to any Disease, and I further acknowledge and agree that in the event of that I (or any of the Permitted Parties) fail to comply with such rules and regulations, Table Mountain Ranch, Inc. reserves the right to terminate my ability (or the ability of any of the Permitted Parties) to participate in Barn Activities, in Table Mountain Ranch, Inc.’s sole discretion.
RECOMMENDATION AND WAIVER USE OF ASTM/SEI APPROVED PROTECTIVE HEADGEAR
Table Mountain Ranch, Inc. and its Management recommend the use of a properly fitting ASTM/SEI approved equestrian helmet for all individuals participating in horseback riding activities. No riders participating in any jumping activities may ride without an approved ASTM/SEI helmet.I understand the additional safety an ASTM/SEI approved equestrian riding helmet provides. I understand that riding without an appropriate helmet increases the risk of injury in the event of an accident. If I choose for myself to ride without an ASTM/SEI approved riding helmet, I assume full responsibility for that decision.
My signature below constitutes acknowledgement that I have read, agree and fully understand the above Agreement. I certify that I am over 18 years old and the information provided is current and accurate.
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