Liability Release Form
for Mimosa Hills Farm LLC
Primary Rider
*
First Name
Last Name
Rider Age
*
Parents name (If applicable) / Responsible Adult
Other minors to be included in this liability release form. Separate by name and age.
E-mail
*
example@example.com
Phone Number
*
Format: (000) 000-0000.
Alternate Phone Number
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Person to be contacted in case of an emergency
*
Name
Relationship
Emergency Contact's Phone Number
*
Type a question
*
Riding/Driving Lessons
Summer Horse Camp
Birthday Party
Working
Farm Tour
Horse in Training
Other
WARNING
*
Under North Carolina law, an equine activity sponsor or equine professional is not liable for an injury to or the death of a participant in equine activities resulting exclusively from the inherent risks of equine activities.
I understand & Agree
*
RELEASE OF LIABILITY * By checking this box and the box above, you agree to waive the liability of all volunteers, employees, managers, trainers, owners and related persons and facilities related to Mimosa Hills Farm, LLC except in the case of gross negligence. You understand that horses and other farm animals and pets are inherently risky and injury or death could result from the fact that horses and any other farm animal or pet can sometimes be unpredictable. Even if well trained and properly managed and all precautions are taken to try to ensure ones safety, injury or death still may occur. Some inherit risks include but are not limited to falling off a horse, getting stepped on, kicked, pinned, bitten, slipping saddles, horses falling or spooking and other direct and indirect actions of the equine and other farm animals or pets. This also includes liable injury from all other animals on or related to Mimosa Hills Farm LLC. Other risks may include but are not limited to being bitten, stepped on, or knocked down by dogs, poultry, exotics, and any other animal or pet on or related to Mimosa Hills Farm LLC. This includes all activities related to summer camps, lessons, trail rides, birthday parties, horse shows, clinics, farm tours, training, recreational riding, casual visits and any other event held on or off of the farm. Please be aware of uneven ground and slippery footing. There are no spectator areas. All areas on the farm are protected by the inherent risk clause.
AGREE TO TERMS
*
I have read and understand the above statements and I verify that I am the parent/guardian and/or I am over the age of 18 years.
Signature
*
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