The Fox Moon Farm Volunteer Form

Name*

First NameLast Name

Email*

example@example.com

Phone Number*

Please enter a valid phone number.

Would you like to receive cool and interesting Fox Moon Farm email updates?

What areas of support are you able to provide? Click all applicable*

Horse exercise/care (experience required)Program support (working with clients/horses)Farm/building maintenanceCommunity GardenGroup Projects (past included fence mending, painting, trail clearing etc.Marketing/Social MediaSpecial Events

Age*

Birthdate

Date

Emergency Contact*

Emergency Contact Phone*

Please enter a valid phone number.

Do you have experience working with horses? If so, please explain.

Date*

Date

Signature*

Participant*

First NameLast Name

This Participation Waiver/Release Agreement is made by and between the undersigned client, volunteer or participant in an equine activity or equine event (the "Participant"), the Participant's parents, guardians, or conservators if the Participant is a minor or ward ("Participant's Parents or Guardians"), and The Fox Moon Farm Project (the "Equine Activity Sponsor" and/or "Equine Professional"). This Agreement is a requirement and condition of participation in any equine activity or equine event conducted, provided, operated, organized or sponsored by the Equine Activity Sponsor or Equine Professional on whose property, facilities, animals, equipment or personnel are used in such connection.

In consideration of the opportunity to participate in equine activities or equine events, the Participant and, if a minor or ward, Participant's Parents or Guardians agree as follows.

1. Inherent Risks. The Participant and Participant's Parents or Guardians acknowledge and understand that horses and activities related to horses are inherently dangerous and that those dangers and conditions integral to equine activities or equine events include, but are not limited to, the propensity of horses to behave in ways that may result in damage to property or injury, harm, or death to persons on or around them (including behaviors such as bucking, biting, rearing, stepping on, falling, stumbling and shying); the unpredictability of a horse's reaction to sounds, movements, unfamiliar objects, persons, or other animals; certain hazards such as surface and subsurface conditions; collisions with other horses, Clients, or objects; the potential for the Participant to act in a negligent manner or otherwise fail to maintain control over the animal; and unpredictable or erratic actions by others on or near animals. Despite these inherent risks, the Participant has chosen, and Participant's Parents or Guardians have chosen to permit the Participant to work with and around horses and participate in equine activities and equine events. The Participant and Participant's Parents or Guardians have considered the Participant's particular physical, mental, and emotional condition or challenges in making this participation decision.

2. Duties and Obligations; Statutory Assumption of Risk and Limitation of Liability. The Participant and Participant's Parents or Guardians are advised that under Virginia law, with certain limited exceptions, an equine activity sponsor, equine professional or any other person engaged in an equine activity is not liable for any property damage or damages arising from the personal injury or death of a participant or spectator resulting from the inherent risks of equine activities. The Participant and Participant's Parents or Guardians are further advised that Virginia law provides that each participant and spectator in an equine activity expressly assumes the risks and legal responsibility for any property damage or damages arising from personal injury or death that results from the inherent risks of equine activities. Each Participant has the sole responsibility for knowing the range of that person's ability to manage, care for and control a particular horse or perform a particular equine activity. It is the duty of each Participant to act within the limits of the Participant's own ability, to maintain reasonable control of the horse at all times while participating in any equine activity or event, to heed all warnings and instructions, and to refrain from acting in a manner that may cause or contribute to the injury of any person or damage to property. The Participant and Participant's Parents or Guardians understand these duties and obligations and have considered the Participant's particular physical, mental, and emotional condition or challenges in undertaking this express assumption of risk.

Release and Waiver. The Participant and Participant's Parents or Guardians understand the risks and dangers inherent in equine activities and do hereby waive and agree not to make any claim or seek any recovery from the Equine Activity Sponsor and Equine Professional and their respective directors, officers, trustees, shareholders, employees, contractors, agents, and assigns for any property damage or damages for personal injury or death resulting from the inherent risks of equine activities. The Participant and Participant's Parents or Guardians hereby further release and discharge the Equine Activity Sponsor and Equine Professional and their respective directors, officers, trustees, shareholders, employees, contractors, agents, and assigns from any and all actions, causes of actions, liabilities, claims, demands, damages, costs and expenses of any kind including, but not limited to, any claim of damages for bodily injury, illness, disease, death or loss of personal property now existing or which may in the future occur or result, directly or indirectly, from participation or involvement in any equine activity, program, or event. The Participant and Participant's Parents or Guardians understand and agree that this Release and Waiver is intended to be as broad as the law allows and specifically covers all claims or demands that may be based in whole or in part on the fault or negligence of the Equine Activity Sponsor and Equine Professional and their respective directors, officers, trustees, shareholders, employees, contractors, agents, and assigns.

WARNING

UNDER VIRGINIA LAW, AN EQUINE ACTIVITY SPONSOR, EQUINE PROFESSIONAL, OR OTHER PERSON ENGAGED IN EQUINE ACTIVITIES HAS LIMITED LIABILITY FOR INJURY OR DEATH RESULTING FROM THE INHERENT RISKS OF EQUINE ACTIVITIES.

Release from Liability and Waiver: Fully informed of these conditions andrisks, I legally bound for myself, my heirs and assigns, executors and administrators, do hereby forever release and hold harmless TheFox Moon Farm Project, Inc. the Board of Directors, officers and all employees and independent contractors and all participating parents from any and all liability, and waive any or all claims for injury, loss or damage caused in whole or part by as a result of me or my child’s participation in the Programs of The Fox Moon Farm Project.

Assumption of Risk: I assume all risks, known and unknown, foreseeable, andunforeseeable, in any way connected with my or my child’s participation in the Programs/Activities/Events as a part of the Fox Moon Farm Project. I accept personal responsibility for any liability, injury, including death, loss ordamage in any way connected with my child’s participation Programs/Activities/Events as a part of the Fox Moon Farm Project.

Date*

Date

Signature*

In the event that emergency medical aid and/or treatment is required due to illness or injury, I authorize The Fox Moon Farm Project to:

1. Secure medical treatment and transportation if needed on my behalf.

2. Release client records upon request to the authorized individual(s) or agency involved in the emergency care.

Physicians/Medical Professional Name*

First NameLast Name

Phone Number*

Please enter a valid phone number.

Preferred Medical Facility if Emergency Care is Needed:

Health Insurance Company: Policy #

Consent Plan:

This authorization includes x-ray, surgery, hospitalization, medication and any other treatment procedures deemed "life saving" by the physician. This provision will only be invoked if the person listed below is unable to be reached.

Consent Signature:

Date

Non-Consent Plan: I do not consent to emergency medical treatment/aid or hospitalization in the case of illness or injury. In the event that emergency care is required, I request the following procedures be followed:

Non-Consent Signature:

Date

Participant Name:*

First NameLast Name

Gender:

Parent/Legal Custodian/Guardian (if participant is child/adolescent):

Address: (if different than above)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email*

example@example.com

Place of Employment (if applicable):

Photo Consent: I do/do not (fill out below) consent to and authorize the reproductionand use of any and all photographs/videos and other visual materials taken of myself or my child/adolescent for promotional material, educational activities, exhibits or any other use for the benefit of the program. I understand and agree that all Photos/Videos are the property of The Fox Moon Farm Project and will not be returned to me.

I acknowledge that I am not entitled to any compensation or royalties with respect to the use of the Photos.

I agree to release and forever discharge The Fox Moon Farm Project and its affiliates, successors and assigns, officers, employees, representatives, partners, agents and anyone claiming through them, in their individual and/or corporate capacities from any and all claims, liabilities, obligations, promises, agreements, disputes, demands, damages, causes of action of any nature or kind, known or unknown, which I, and anyone claiming on behalf of me, may have or claim to have against Releasee in connection with this Release.

I Consent*

YesNo

Consent (if participant is a minor): I, the parent/legal custodian/legal guardian of the abovenamed minor, do hereby give my consent for his/her participation in Programs/Activities/Events as a part of the Fox Moon Farm Project. These Programs may include our one-day Farm Events, our Healing with Horses Program and other Special Events.

Signature*

Print (Parent, Legal Custodian, Legal Guardian, if minor)*

Date*

Date

Volunteer Form

WAIVER/RELEASE AGREEMENT

AUTHORIZATION FOR EMERGENCY MEDICAL TREATMENT

PARTICIPATION/PHOTO RELEASE FORM