FLYING CROSS RANCH
ACKNOWLEDGEMENT OF RISK AND RELEASE OF LIABILITY
Participant Name
First Name
Last Name
Parent/Guardian Name If Under 18
First Name
Last Name
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Age If Participant Is UNDER 18
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Month
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Day
Year
Date
THE PARTICIPANT OR PARENT/GUARDIAN MUST READ AND UNDERSTAND PRIOR TO THE CHILD PARTICIPATING IN EQUINE ACTIVITIES
To: 9066357 Canada Limited Operating as FLYING CROSS RANCH
(NAME OF PERSON, ORGANIZATION OR COMPANY PROVIDING THE EQUINE ACTIVITIES)
Their directors, employees, officers, 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 or parent/legal guardian of the child participant named above and am executing form on behalf of myself or the child participant.
2. I understand there are Inherent DANGERS, HAZARDS and RISKS, (collectively called RISKS) associated with equine activities and injuries resulting from these "RISKS" can occurrence.
3. I acknowledge 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 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 it remains my sole responsibility for the safety myself and/or the child Participant and for the myself/ and or the child to participate within his/her own limits.
6. In addition to consideration given for the myself or the child 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 child 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 child participant or our “Legal Representatives” might suffer as a result of the participants participation due to any cause including any NEGLIGENCE ON THE PART OF THE “HOST” • LESS AND INDEMNIFY THE “HOST” from any and all liability for property damage or personal injury to the participant or to any third party which might result from the participation.
7. I/we agree to assume the responsibility and all risk from the use and rental of horses from Flying Cross Ranch and further agree to hold Flying Cross Ranch owners, instructors, trainers, employees and volunteers free from all damages of liability for any injury to person or property arising as a result of use, rental or lesson, of said horse or equipment or while staying at Flying Cross Ranch.
8. I/we further acknowledge that any physical or mental disabilities have been fully and absolutely disclosed and that accepting such full and complete disclosure there are no other medical reasons that would affect my participation in equine activities.
9. I hereby give staff permission to arrange for any emergency medical care including hospitalization if necessary.
10. I/we give Flying Cross Ranch permission to take photographs and or videos of the above named person for instruction or publicity purposes.
Before 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 or my “Legal Representatives” might have against the “HOST”.
Date
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Year
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Signature
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