Registration and Liability Release

Registration and Liability Release
Your Name

First NameLast Name
Cell Phone
Email
example@example.com
I will attend: (check all that apply)
Guest Name
Guest Cell Phone

SECTION 1 – AUDITOR INFORMATION
Full Name (Participant)
Emergency Contact Name
Emergency Contact Phone
Please enter a valid phone number.Format: (000) 000-0000.
SECTION 2 – REQUIRED VIRGINIA WARNING
"WARNING"

Attention: "Under Virginia law, an equine activity sponsor or equine professional is not liable for an injury to or the death of a participant in equine activities resulting from the inherent risks of equine activities." Code of Virginia 3.2-6200 through 3.2-6203
SECTION 3 – ACKNOWLEDGMENT OF RISK
I acknowledge that equine activities involve inherent risks, including but not limited to: The propensity of horses to behave in ways that may result in injury, harm, or death; The unpredictability of a horse’s reaction to sounds, movement, objects, or animals; Surface and subsurface hazards; Collisions with other horses, animals, people, or objects; My own actions or inactions contributing to injury
SECTION 4 – RELEASE AND WAIVER OF LIABILITY
Release and Waiver of Liability
SECTION 5 – HELMET & SAFETY ACKNOWLEDGMENT
Helmet & Safety Acknowledgment
SECTION 6 – PHOTO / VIDEO RELEASE
Photo / Video Release
SECTION 7 – MINOR PARTICIPANT (IF UNDER 18)
Minor Name
Minor Parent/Guardian Consent
Parent/Guardian Name
Parent/Guardian Email
example@example.com
Parent/Guardian Phone
Please enter a valid phone number.Format: (000) 000-0000.
SECTION 8 – ELECTRONIC SIGNATURE CONSENT
Electronic Signature Consent
SECTION 9 – SIGNATURE
Typed Name (Legal Signature)
Date

MonthDayYear
Date
Should be Empty:

Registration and Liability Release

SECTION 1 – AUDITOR INFORMATION

SECTION 2 – REQUIRED VIRGINIA WARNING

SECTION 3 – ACKNOWLEDGMENT OF RISK

SECTION 4 – RELEASE AND WAIVER OF LIABILITY

SECTION 5 – HELMET & SAFETY ACKNOWLEDGMENT

SECTION 6 – PHOTO / VIDEO RELEASE

SECTION 7 – MINOR PARTICIPANT (IF UNDER 18)

SECTION 8 – ELECTRONIC SIGNATURE CONSENT

SECTION 9 – SIGNATURE