RMBCH Event Liability Waiver ONLINE Version

Ride Location (Choose as close as you can. Fun or Work ride is also fine.)*

Event Date *

Date

Event Leader Name (this field has been replaced and no longer shows on form)

Event Leader Name*

Participant Name*

First NameLast Name

Email of Participant*

example@example.com

WARNING: Under Colorado law, an equine event sponsor is not liable for any injury or death of a participant in equine activities resulting from inherent risks of equine activities, pursuant to section 13-21-119, Colorado revised statutes. I (we) release the Rocky Mountain Back Country Horsemen, its officers, directors, and members of any and all liability which may arise as a result of injury to my (our) person(s) or property that may be sustained in connection withthe chapter activities. It is the recommendation of RMBCH that children and adults wear an equestrian-approved helmet and safety vest. If aparent chooses to not require these safety precautions, he/she is accepting responsibility for any injuries that may occur, and he/she further agrees to hold the RMBCH chapter and its officers, directors, and members blameless.

I HAVE READ, ACKNOWLEDGE, AND ACCEPT THE LIABILITY STATEMENT*

YESNO

INITIALS HERE - I HAVE READ, ACKNOWLEDGE, AND ACCEPT THE LIABILITY STATEMENT*

RMBCH Ride Rules I have read the online Ride Rules. I understand and agree to those ride rules which include • Ride at your own risk. The health and safety of me and my equine are my own responsibility at all times. No foul language and be respectful of other riders. Ride waivers are required to ride. Be saddled and ready (release signed etc.) at the time listed for the ride. No Dogs or Stallions. No riding double. Cantering will be controlled and at the discretion of the trail boss.*

YESNO

INITIALS HERE - RMBCH Ride Rules I have read the online Ride Rules. I understand and agree to those ride rules which include • Ride at your own risk. The health and safety of me and my equine are my own responsibility at all times. No foul language and be respectful of other riders. Ride waivers are required to ride. Be saddled and ready (release signed etc.) at the time listed for the ride. No Dogs or Stallions. No riding double. Cantering will be controlled and at the discretion of the trail boss.*

HEALTH I understand the health and physical condition requirements for this event, and I know of no medical condition or physical limitation that may adversely affect my ability to participate in this activity.*

YESNO

Emergency Contact

First NameLast Name

Emergency Contact Phone

Please enter a valid phone number.Format: (000) 000-0000.

Participant Signature *

Burden Statement: Completing this form is voluntary, but failure to provide the information will prevent program participation. According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information