Acknowledgement of Risk & Release of Liability

Acknowledgement of Risk & Release of Liability - Over the Age of Majority

Jade Farrington, Nicole Neddow, Justine Wylie, Megan Desjardins & Hot 2 Trot Stables
For Participants Over the Age of Majority in the Province or Territory in which the Equine Activities are provided by the Host.

WARNING: THIS AGREEMENT WILL AFFECT YOUR LEGAL RIGHTS. READ IT CAREFULLY!

Every Person Must Read and Understand this Waiver Before Participating in Equine Activities.

The following waiver of all claims, release from all liability, assumption of all risks, agreement not to sue and other terms of this agreement are entered into by me (the Participant) with and for the benefit of Jade Farrington, Nicole Neddow, Justine Wylie, Megan Desjardins, Hot 2 Trot Stables, directors, officers, employees, volunteers, business operators, agents and site property owners or lessees (collectively the "Host"). Without limiting the generality of foregoing, "Equine Activities" includes bu is not limited to competitions, tournaments organized and/or operated by the "Host", riding instruction, coaching and training provided by the "Host" to the Participant.

INITIAL EACH ITEM BELOW AFTER READING & UNDERSTANDING EACH ITEM:
1. I am aware that there are inherent dangers, hazards and risks (collectively "Risks") associated with "Equine Activities" and injuries resulting from these "Risks are a common occurrence. I am aware that the "Risks" of "Equine Activities" mean those dangerous conditions which are an integral part of "Equine Activities", including but not limited to: (a) the propensity of any equine to behave in ways that may result in injury, harm or death to persons on or around them and to potentially collide with, bite or kick other animals, people or objects; (b) the unpredictability of an equine's reaction to such things as sounds, sudden movement, tremors, vibrations, unfamiliar objects, persons or other animals and hazards such as subsurface objects; (c) the potential for other participants to behave in a negligent manner may contribute to injury to themselves or others, including failing to act within their abilities to maintain control over an equine. (d) the potential of natural or man-made hazards being present that can cause me harm, including communicable disease.*

I HAVE READ & UNDERSTAND THE ABOVE STATEMENT(S)
INITIAL*

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2. I freely accept and fully assume all responsibility for all "Risks" and possibilities of any and all personal injury, sickness, disease, medical payments, death, property damage or loss resulting from my participation in "Equine Activities".*

I HAVE READ & UNDERSTAND THE ABOVE STATEMENT(S)
INITIAL*

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3. I agree that although the "Host" has taken steps to reduce the "Risks" and increase the safety of the "Equine Activities", it is not possible for the "Host" to make the "Equine Activities" completely safe. I accept these "Risks" and agree to the terms of this waiver even if the "Host" is found to be negligent or in breach of any duty of care or any obligation to me in my participation in "Equine Activities".*

I HAVE READ & UNDERSTAND THE ABOVE STATEMENT(S)
INITIAL*

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4. In addition to consideration given to the "Host" for my participation in "Equine Activities:, I and my heirs, next of kin, executors, administrators and assigns (collectively my "Legal Representatives") agree: (a) to waive all claims that I have or may have in the future against the "Host"; (b) to release and forever discharge the "Host" from all liability for any personal injury, death, property damage, or loss resulting from my participation int he equine activity due to any cause, including but not limited to negligence (failure to use such care as a reasonably prudent and careful person would use under similar circumstances), breach of any duty imposed by law, breach of contract or mistake or error in judgement of the "Host"; and (c) to be liable for and hold harmless and indemnify the "Host" from all actions, proceedings, claims, damages, costs demands, including court costs and costs on a solicitor and own client basis, and liabilities of whatsoever nature or kind arising out of or in any way connected with my participation in "Equine Activities."*

I HAVE READ & UNDERSTAND THE ABOVE STATEMENT(S)
INITIAL*

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5. I agree that this waiver and all terms contained herein are governed exclusively and in all respects by the laws of the Province or Territory of Canada in which "Equine Activities" are provided by the "Host". I hereby irrevocably submit to the exclusive jurisdiction of the courts of that Province or Territory of Canada and I agree that no other court can exercise jurisdiction over the terms and claims referred to herein. Any litigation to enforce this waiver will be instituted in the Province or Territory of Canada in which "Equine Activities" are provided by the "Host".*

I HAVE READ & UNDERSTAND THE ABOVE STATEMENT(S)
INITIAL*

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6. I confirm that I have had sufficient time to read and understand this waiver in it's entirety. I understand that this agreement represents the entire agreement between myself and the "Host", and it is binding on myself and my "Legal Representatives".*

I HAVE READ & UNDERSTAND THE ABOVE STATEMENT(S)
INITIAL*

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7. I confirm that I have reached the age of majority in the province in which I am participatin in "Equine Activities".*

I HAVE READ & UNDERSTAND THE ABOVE STATEMENT(S)
INITIAL*

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Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Date of Birth*

MonthDayYear
Date
Signature*

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Please verify that you are human*
RIDER MEDICAL PROFILE
CONTACT INFORMATION:
Name

First NameMiddle NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.
Cell
Please enter a valid phone number.
Emergency Contact Information
1. Contact Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Second Phone Number
Please enter a valid phone number.
Relationship
2. Contact Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Second Phone Number
Please enter a valid phone number.
Relationship
3. Contact Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Second Phone Number
Please enter a valid phone number.
Relationship
PERSONAL INFORMATION
Health Card Number
Name on Health Card
Height of Participant
Weight of Participant
Any known allergies? If yes, please elaborate:
Any permanent or temporary disabilities? If yes, please elaborate.
Any past known medical conditions? If yes please elaborate.
Do you have any braces or other dental devices? Please elaborate.
Do you wear a medical alert bracelet? If yes, please elaborate.
Last date of tetanus vaccination

MonthDayYear
Date
Blood type (if known)
Do you have any of the following? Please check all that apply

ArthritisChronic NosebleedsAsthmaChronic NosebleedsDiabetesDiphteriaDislocating Joint(s)DizzinessEpilepsyFaintingHeadachesHeart TroubleHerniaSkin ConditionStomach ProblemsSwollen/Painful JointsTrick or Lock KneePrevious BreaksWear Glasses
If you checked any of the above boxes, please elaborate and describe any modifications that will contribute to your comfort while riding:
Do you take any medications? If yes, please list them
Any other additional information:
Should be Empty:

Acknowledgement of Risk & Release of Liability - Over the Age of Majority

RIDER MEDICAL PROFILE

CONTACT INFORMATION:

Emergency Contact Information

PERSONAL INFORMATION