Address:
106066 S. 3450 Rd. Meeker, OK
74855
Phone:
405-820-6545
Email:
singinggraceranch@yahoo.com
Liability and Hold Harmless Agreement
I HEREBY ASSUME ALL OF THE RISKS OF PARTICIPATING IN ANY/ALL ACTIVITIES ASSOCIATED WITH SINGING GRACE RANCH'S VOLUNTEERING AND VISITS, including by way of example and not limitation, any risks that may arise from negligence or carelessness on the part of the persons or entities being released, from dangerous or defective equipment or property owned, maintained, or controlled by them, or because of their possible liability without fault. Examples of potential risks I am agreeing to include, but are not limited to: injuries, death or property damage from: mounting; riding; dismounting; walking/leading; grooming; feeding; petting; use of horse stalls, arena, trails, or round pen in any capacity; falling off horse whether horse is bucking, flipping, rearing, spooked; or my failure to understand any equine professional's(s') directions related to my riding or otherwise use or control of, or lack thereof, of my horse or the horse I have been assigned to. Furthermore, I assume all of the risks of participating in the interaction and handling of all farm animals on the property of Singing Grace Ranch, including, but not limited to: goats, miniature horses, ponies, donkeys, pigs, chickens, dogs, and cats.
I certify that I am physically fit for this activity, and have not been advised to not participate by a qualified medical professional. I certify that there are no health-related reasons or problems, which preclude my participation in this activity. I acknowledge that this Accident Waiver and Release of Liability Form will be used by the event holders, sponsors, and organizers of the activity in which I may participate, and that it will govern my actions and responsibilities at said activity. In consideration of my participation in this activity, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows:
(A) I WAIVE, RELEASE, AND DISCHARGE from any and all liability, including but not limited to, liability arising from the negligence or fault of the entities or persons released, for my death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter occur to me including my traveling to and from this activity, THE FOLLOWING ENTITIES OR PERSONS: Singing Grace Ranch and/or their directors, officers, employees, volunteers, representatives, and agents, and the activity holders, sponsors, and volunteers;
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(B) INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE the entities or persons mentioned in this paragraph from any and all liabilities or claims made as a result of participation in this activity, whether caused by the negligence of release or otherwise. I acknowledge that Singing Grace Ranch and their directors, officers, volunteers, representatives, and agents are NOT responsible for the errors, omissions, acts, or failures to act of any party or entity conducting a specific activity on their behalf.
I acknowledge that this activity may involve a test of a person's physical and mental limits and carries with it the potential for death, serious injury, and property loss. The risks include, but are not limited to, those caused by terrain, facilities, animals, temperature, weather, condition of participants, equipment, vehicular traffic, lack of hydration, and actions of other people including, but not limited to, participants, volunteers, monitors, and/or producers of the activity. These risks are not only inherent to participants, but are also present for volunteers.
I understand Oklahoma Law states, "Except as provided in subsection B of this section, a livestock activity sponsor, a participant or a livestock professional acting in good faith and pursuant to the standards of the livestock industry shall not be liable for injuries to any person engaged in livestock activities when such injuries result from the inherent risks of livestock activities." Under the Oklahoma Statutes as Section 50.3 of Title 76.
I hereby consent to receive medical treatment which may be deemed advisable in the event of injury, accident, and/or illness during this activity. I understand I will be financially responsible for the bills incurred.
Signature of Participant:
Print Name:
Date:
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If under the age of 18 years old:
Signature of parent or legal guardian:
Print Name:
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Emergency Treatment Information
Participant Name:
Date of Birth:
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Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Primary Care Doctor's Name:
Phone:
Allergies:
Insurance Company Name:
Insurance Policy Number:
In the event of a medical emergency please contact:
Name:
Phone:
Relation:
Name:
Phone:
Relation:
Name:
Phone:
Relation:
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