Blazing Hope Release of Liability

Blazing Hope Youth-Family Ranch Release of Liability

READ CAREFULLY AND COMPLETE ALL SECTIONS BEFORE SIGNING

This form is for families only.

No, need to print just click submit at the bottom of this page.

Confirmation is sent to your email.

WARNING:

Under Idaho Law, an equine professional is not liable for an injury to or the death of a participant in equine activities resulting from the inherent risks of equine activities, pursuant to Title 6 Chapter 18

Idaho Equine Activities Immunity Act

Name of Parent/Guardian 1*

First NameLast Name

Phone #*

Date of Birth*

Date

Please Check all that currently apply*

AGE 18 or olderOver 240 lbsUnder 10 hours riding experienceOr, over 10 hours riding experience

Do you have any physical or mental condition(s), which may affect his / her safety and ability to ride and/or train a horse?*

yesno

If you checked "YES," how can we help them with their special needs?

Name of Parent/Guardian 2

First NameLast Name

Phone #

Date of Birth

Date

Please Check all that currently apply

AGE 18 or olderOver 240 lbsUnder 10 hours riding experienceOr, over 10 hours riding experience

Do you have any physical or mental condition(s), which may affect his / her safety and ability to ride and/or train a horse?

yesno

If you checked "YES," how can we help them with their special needs?

Mailing Address*

Address (If different)

Street Address Line 2

CityState

Zip

Home Address ( if different)

Email*

example@example.com

Preferred contact method. phone, email, text*

List Children(s) Names and Birthdates below*

List Children(s) Names and whether or not they have under 10 hours or over 10 hours of riding experience.*

Do any of your children have any physical or mental condition(s), which may affect his / her safety and ability to ride and/or train a horse?*

If you checked "YES," which child and how can we help them with their special needs?

I, the undersigned, warrant and agree that I will make no claim or file suit for any injury to person or property, or for any loss or destruction of any article of any kind or nature in connection with my participation at Blazing Hope Youth-Family Ranch. I understand that the Blazing Hope Youth-Family Ranch nor their officers, directors, contractors or staff accept any responsibility for accidents, damage, injury or illness to the riders, horses, members, sponsors, agents, spectators or any other person or property owner in connection with operation at Blazing Hope Youth-Family Ranch. I understand that there are inherent risks in my participation and those risks are assumed by me. I fully understand that animals (horses) and conditions are unpredictable and that the risk of injury or death is inherent to the activity of horseback riding and/or being around horses. I fully assume the responsibility for the risk of injury or death caused by my contact with horses and horseback riding. I completely release Blazing Hope Youth-Family Ranch and theirofficers, directors, contractors or staff from any and all liability for any and all injuries or death to me caused by mycontact with horses and/or horseback riding. Signing of this form binds me to this hold harmless agreement. This document will be constructed under the laws of the State of Idaho.

Today's Date*

Date

Signature*

I hereby grant Blazing Hope Youth-Family Ranch and their officers, directors, contractors or staff permission to take or have taken still or moving photographs and videos and authorize the Blazing Hope Youth-Family Ranch to reproduce said photographs and use them at their discretion (i.e. brochures, websites, Social Media etc*

**Please add at least one emergency contact**

In the event that I or my minor child, have an emergency, and a parent/guardian named above cannot be reached,

Please contact the following trusted Emergency Contacts:

(1) Name*

Relationship*

PHONE*

(2) Name

Relationship

PHONE

Preferred medical facility*

Health insurance company

Policy #

Family physician

Phone#

~Medical information~

medications, allergies etc

Please specify whether this applies to which Parent or Child.

Illness

Medication(s)

Allergies

Other

I authorize Blazing Hope Youth-Family Ranch officers, directors or staff to obtain medical assistance for me/my child. As a parent/guardian of , a minor child or myself, I hereby authorize Blazing Hope Youth-Family Ranch officers, directors or staff to obtain medical aid for the above-named child or myself. I understand that this authorization will be used only in the case of an emergency, and if the speed of treatment is essential to the well-being of my child or myself in the case of an injury, the child or I will be taken to the nearest hospital. I also understandthatIreleaseRanchdirectorsorstafffromandallfor officers,liability BlazingHopeany Youth-Family decision made in regard to my child's or my injury, care or hospitalization. If I do not consent to authorize Blazing Hope Youth-Family Ranch officers, directors or staff to arrange medical care, I will specify on paper that will then be attached to this as to my desired course of action. The fee for treatment will be paid by the undersigned. I am aware Blazing Hope Youth-Family Ranch does not provide medical coverage to participants/volunteers.

Today's Date*

Signature*

Blazing Hope Youth-Family Ranch 26512 Farmway Rd Caldwell, ID 83607

Revised August 2023

Parent/Guardian Section

Child(ren) Section

PHOTO AND VIDEO RELEASE

AUTHORIZATION TO ARRANGE MEDICAL CARE