Liberty Clinic- Tennessee
Sept 20-21, Dunlap TN Clinics@versatilehorses.com for questions
Name
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First Name
Last Name
Email
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example@example.com
Phone Number
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Please enter a valid phone number.
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Tell us about your equine background and goals for this clinic
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Tell us about the horse you’re bringing to this clinic
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Emergency contact name and phone number
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Please check any of these you require for the weekend. Will be paid upon your arrival to the clinic
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Auditing $60/ day
Participating $610 for the weekend; includes lunch both days, water, grounds fee; and self care stall with 2 bags of shavings
Auditing lunch $15/ day
I will bring my horse’s current (12 month), negative coggins paperwork with me to the clinic
Yes
Clinic Payment to Versatile Horsemanship: Send $250.00 non-refundable deposit payment using Venmo friends and family: @versatilehorses last 4 digits are 3777 - or - Zelle: 940-465-3777. I can invoice you via square for an additional 3.5% fee. Your spot in the clinic is saved once the deposit is received. Remember, your deposit DOES count towards the full price of the clinic and IS refundable if the clinic host OR clinician has to cancel. After your deposit is paid, you will pay the remainder of your balance and any extras at the event.*
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I will send a deposit to hold by place in the clinic by Venmo - @versatilehorses last 4 digits are 3777
I will send a deposit to hold by place in the clinic by Zelle- 940-465-3777.
I will send a deposit to hold by place in the clinic by Square
I am auditing only and will pay upon arrival
How did you hear about this clinic
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Waiver and Photo/Video ReleaseIn consideration of receiving permission to participate in the above named program, or any activity associated with the above named program, I do hereby release, waive, discharge and covenant not to sue Versatile Horsemanship LLC, any officers, servants, agents, or employees (hereinafter referred to as releasees) from any and all liability, claims, demands, actions and causes of action whatsoever arising out of or related to any loss, damage or injury, including death, that may be sustained by me, or to any property belonging to me, whether caused by the negligence of the releasees, or otherwise, while participating in said programs, or while in or upon any premises where said programs are being conducted. I am fully aware of the inherent risks and hazards connected with participating in activities with farm animals. I acknowledge that farm animals are unpredictable and potentially dangerous whether I am riding, handling (i.e. leading, grooming, directing on the ground, auditing, or being in the presence of, etc.), and have full understanding of the kinds of occurrences and hazards that may exist during or as part of my activities, including the potential for serious injury or death. I hereby elect to voluntarily participate in said programs, and to enter the above named premises and engage in such activity, knowing that the activity may be hazardous to me or my property. I voluntarily assume full responsibility for any risks of loss, property damage, or personal injury, including death, that may be sustained by me, or any loss or damage to property owned by me, as a result of being engaged in such activity, whether caused by the negligence of releasees, or otherwise. I further hereby agree to indemnify and hold harmless the releasees from any loss, liability, damage or costs, including court costs and attorney’s fees, that may incur due to my participation in said activity, whether caused by negligence of releasees, or otherwise. It is my express intent that this release and hold harmless agreement shall bind the members of my family and spouse, if any, if I am alive, and my heirs, assigns and personal representative, if I am deceased, and shall be deemed as a release, waiver, discharge and covenant not to sue the above named releasees. I hereby further agree that this waiver of liability and hold harmless agreement shall be considered in accordance with the laws of the State of Texas. FILM/VIDEO RELEASE / VERSATILE HORSEMANSHIP LLC: I, (Owner), for good and valuable consideration, the receipt of which is acknowledged, give to the Versatile Horsemanship LLC ("Manager"), its legal representatives, successors, and all persons or corporations acting with its permission, unrestricted permission to copyright and/or use, and/or publish photographic portraits or pictures of the Owner or the Owner’s horse, and the negatives, transparencies, prints, or digital information pertaining to them, in still, single, multiple, moving or video format, or in which the Owner or Owner’s horse may be included in whole or in part, or composite, or distorted in form, or reproductions thereof, in color or otherwise, made through any media in photographer's studio or elsewhere for art, or any other lawful purpose. I hereby waive any right that I may have to inspect and approve the finished product or copy that may be used in connection with an image that Versatile Horsemanship, LLC or its agents, employees, and representatives has taken of the Owner or the Owner’s horse, or the use to which it may be applied. I further release Manager, Versatile Horsemanship LLC or others for whom Versatile Horsemanship LLC is acting, from any claims for remuneration associated with any form of damage, foreseen or unforeseen, associated with the proper commercial or artistic use of these images unless it can be shown that said reproduction was maliciously caused, produced and published for the sole purpose of subjecting the Owner or Owner’s horse to conspicuous ridicule, scandal, reproach, scorn and indignity. I acknowledge that the videotaping/photography session was conducted in a completely proper and highly professional manner, and this release was willingly signed at its termination. I certify that I am not a minor, and if a minor, have permission from my parent or legal guardian signed below, and am free and able to give such consent. In signing this release, I acknowledge and represent that I have read the foregoing waiver of liability and hold harmless agreement, understand it, and sign it voluntarily as my own free act and deed; no oral representation, statements, or inducements, apart from the foregoing written agreement have been made; I am at lease eighteen (18) years of age, fully competent, and I execute the release for full, adequate and complete consideration fully intending to be bound by same. I give my permission, in the event that my family physician or dentist cannot be reached by phone, for releasees to make appropriate arrangements for emergency care whether it be by a physician or dentist, or medical or dental facility should I become injured or ill while participating in this class. It is understood that I will assume any financial responsibility for any medical or dental expenses that may be incurred for said emergency or emergencies*
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This is my virtual signature
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