High Horses Liability and Photo Release

Acknowledgement/Assumption of Risk and Liability Release

Name*

Date of Birth*

Date

Address*

Address

Street Address Line 2

CityState

Zip

Day Phone*

Evening Phone*

Email*

example@example.com

Emergency contact 1*

Emergency Contact 1 Relation*

Contact #1's phone*

Emergency contact 2*

Emergency Contact 2 Relation*

Contact #2's phone*

Acknowledgement/Assumption of Risk:

I would like to participate in the programs and services offered at High Horses Center for Equine-Assisted Services (HHCEAS I acknowledge the inherent risks and potential for risks of equine activities However, I assume these risks and feel the possible benefits to me/ my son/my daughter/my ward are greater than the risks assumed.

Warning Under Vermont Equine Activities Law:

I further acknowledge that under Vermont law (12 V.S.A. 1039), an equine activity sponsor is not liable for injury to, or the death of, a participant in the equine activities resulting from the inherent risks of equine activities that are obvious and necessary. The term "equine activity sponsor" includes the HHCEAS, its employees, volunteers, instructors, therapists, contractors, agents and members of its board of directors.

Liability Release:

In consideration for the opportunity to participate in the programs and services offered at HHCEAS, I release HHCEAS and its employees, volunteers, instructors, therapists, contractors, agents and members of its board of directors from all claims, suits, judgments, losses, and expenses, including those associated with the COVID-19 coronavirus, arising in whole or in part from my participation in the HHCEAS.

I consent to and authorizeI do not consent to nor do I authorize

the use and reproduction by High Horses Center for Equine-Assisted Services of any and all photographs and any other audiovisual materials taken of me for promotional printed material, educational activities exhibitions, or for any other use for the benefit of the program.

Signature*

Date*

Date