Acknowledgement/Assumption of Risk and Liability Release
Name:
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First Name
Last Name
Date of Birth:
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Address:
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Mobile Phone:
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Email:
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example@example.com
Emergency contact:
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Emergency contact phone:
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Emergency contact relation:
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If attending with a group/organization, let us know which one:
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.
Photo Release
I hereby grant permission to High Horses Center for Equine-Assisted Services the use of photographs, videos, and any other audio/visual media taken of me for promotional materials and publications, educational activities, exhibitions or for any other use for the benefit of the program. I further understand that by signing this release form, I waive any and all present and future rights of compensation or ownership regarding such uses and understand that all materials remain the property of High Horses Center for Equine-Assisted Services.
Photo Release Consent
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YES - I CONSENT to photos/publicity release
NO - I DO NOT CONSENT to photos/publicity release
Signature:
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Date:
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Updated 8/2024
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