FIELD TRIPS RANCH LIABILITY FORM

TODAYS DATE*

Date

PHONE NUMBER*

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CLIENT'S NAME*

First NameLast Name

GUARDIAN'S NAME IF CLIENT IS A MINOR

First NameLast Name

EMAIL*

example@example.com

CLIENT'S DOB*

Date

EMERGENCY CONTACT*

First NameLast Name

EMERGENCY CONTACT NUMBER*

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ALLERGIES TO MEDICATIONS

CURRENT MEDICATIONS

INSTRUCTIONS FOR MEDICAL STAFF IN A CASE OF AN EMERGENCY

NAME OF SCHOOL OR GROUP

Authorization, Liability Release, Indemnification and Assumption of Risk Agreement
PLEASE READ CAREFULLY AND COMPLETE ALL SECTIONS BEFORE SIGNING

Bit of Hope Ranch Hereinafter known as "Ranch”

Bit of Hope Ranch Inc. Equine/Ranch Activities, Educational and Therapeutic Program Release of Liability & Assumption of Risk Agreement

NOTICE: THIS IS A LEGALLY BINDING AGREEMENT. Bit of Hope Ranch programs include a working equine facility complete with livestock and farm equipment. The Ranch also has a low ropes course, portable low element activities, natural playground, pond and inflatables. These activities can be strenuous and psychologically demanding and require participants to be in good physical condition. Although the programs use trained staff/volunteers and regularly inspect the low ropes course, it is impossible to foresee all possible dangers. Some specific risks the participant may encounter while using the equine activities, therapeutic programs, educational programs, recreational outdoor programs or low ropes course might include, but are not limited to, injury or loss of life from slipping, falling, running, horse bites, horse kicks, and injury from horseback.

Participant is aware and understands that participating in Bit of Hope Ranch's programs involves a potential risk of physical injury or loss of life that may not only be from his/her own actions, inactions, or negligence, but also from the actions, inactions, or negligence of others, the condition of the environment, equipment, or areas where the event or activity is being conducted.

Participant understands that the programs are physically demanding and potentially dangerous. Therefore, all participants must be free of medical or physical conditions, which might create undue risk to themselves or others who depend on them. If there are any questions about the participant’s ability to participate, please consult with the participant’s physician prior to signing this form or participating in the program.
Participant understands that he/she is responsible for behaving in a careful and prudent manner to minimize the risk of injury to themselves or others.
Participant understands that this is a voluntary program and that he/she should participate to the extent that they feel appropriate for their own condition and skill level ("challenge by choice").

Participant will not be able to participate if under the influence of drugs or alcohol.

Photo Release.

I hereby authorize Bit of Hope Ranch, the absolute and irrevocable right and permission, in respect of the photographs that have been, or will be taken of the PARTICIPANT or in which the PARTICIPANT may be included with others, to copyright the same, in the name of the Ranch or otherwise, to use, re-use, publish, and republish the same in whole or in part, individually or in conjunction with other photographs, and in conjunction with any printed matter, in any and all media now or hereafter known, and for any purpose whatsoever; and to use my name in connection therewith. I hereby release and discharge the Ranch from any and all claims and demands arising out of or in connection with the use of the photographs, including without limitation any and all claims for libel or invasion of privacy. Note that the privacy of clients is protected and will pictures will not be used without prior permission.

INITIALS

Medical Consent

In the event my Child becomes injured or sick while on the premises of the Ranch, I hereby authorize and consent to the Ranch staff providing first aid, as well as in accord with their best judgment, to summon medical professionals at my expense for the medical treatment of my Child.

INITIALS

Release/Indemnification and Covenant Not to Sue

RATHLEAD LIABILITY RELEASE and BIT OF HOPE RANCH RELEASE: As a PARTICPANT at Bit of Hope Ranch, Inc., I acknowledge the risks and potential for risks of an equine therapeutic, equine recreational, educational and Low Ropes Course related program. However, I feel that the possible benefits to me are greater than the risk assumed. I hereby, intending to be legally bound, for myself, my heirs and assigns, executors or administrators, waive and release forever all claims for damages against Rathlead Farms, LLC and Bit of Hope Ranch, Inc. and their members, Board of Directors, volunteers, contract staff and/or employees for any and all injuries and/or losses I may sustain while participating in activities at Bit of Hope Ranch, Inc.

I HAVE READ THIS DOCUMENT AND AGREE TO ALL OF ITS TERMS. I UNDERSTAND IT BECOMES A LEGALLY BINDING CONTRACT UPON EXECUTION BY THE RANCH AND THAT IT WAIVES CERTAIN LEGAL RIGHTS OF MINE AND OF MY CHILD INCLUDING BUT NOT LIMITED TO A RELEASE, DISCHARGE, INDEMNIFICATION, PROMISE NOT TO SUE, AND HOLD HARMLESS FROM ALL CLAIMS THAT CAN BE MADE AGAINST THE RANCH AND ITS OWNERS, AGENTS, CONTRACTORS, VOLUNTEERS AND EMPLOYEES. IT IS THE INTENT OF THIS AGREEMENT THAT IT SHALL BE BINDING UPON MYSELF, MY CHILD(REN) AND ANYONE ATTEMPTING TO ACT ON BEHALF OF MY CHILD(REN) AND OUR ESTATES SUCCESSORS AND ASSIGNS.

GUARDIAN/PARENT OR CLIENT SIGNATURE (IF OVER 18 YEARS OLD)

FIELD TRIP BIT OF HOPE RANCH WAIVER AND LIABILITY RELEASE FORM