• Horse Camp Registration Form

    Please fill out your details to register for the camp at our equine counseling farm.
  • Date of Birth*
     - -
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • EQUINE ACTIVITY LIABILITY RELEASE, WAIVER OF RIGHT TO SUE AND ASSUMPTION OF

    ALL RISKS

    THIS EQUINE ACTIVITY LIABILITY RELEASE, WAIVER OF RIGHT TO SUE AND ASSUMPTION OF
    ALL RISKS ("this Agreement") is hereby given by the undersigned (i)To Barnabas Stables, Inc., the
    Equine Activity Sponsor and/or Equine Activity Professional (the "Sponsor/Professional"), (ii)To the
    Sponsor/Professional as agent for and the benefit of each Owner of land upon which an equine
    activity to which this Agreement relates is conducted and as Agent of and for the benefit of each
    Owner of an equine used by the Sponsor/Professional ("Owner"), (iii)To persons who provide
    facilities for equine activities (the "Equine Activity Sponsor") and (iv)To each partner, officer, agent,
    employee, director, shareholder, heir, personal representative, successor and assign of the Sponsor/
    Professional, of each Owner and of the Equine Activity Sponsor (who also shall be included within
    the words "Sponsor/Professional", "Owner" or "Equine Activity Sponsor" as their relationships may
    determine) and provides as follows:
    In consideration for the opportunities provided by the Sponsor/ Professional, each Owner and the
    Equine Activity Sponsor to the undersigned Participant (including any minor Participant for whom
    he/she signed this Agreement) for the enjoyment of equine activities as a Participant (the
    "Participant"), the Participant hereby agrees as follows:
    1. This Agreement is given in part under the Virginia Equine Activity Liability Act (Code of Virginia
    Section 3.2-6200, et seq,) as it may now provide or be hereafter amended (the "Act"). All terms
    defined by the Act shall have the same meaning herein, and the Act is hereby incorporated into this
    Agreement by reference. This Agreement shall be so construed as to provide to the Sponsor/
    Professional, each Owner and the Equine Activity Sponsor the fullest protection of a Release,
    Waiver of Right to Sue and Assumption of All Risks which is afforded by the Act, by other
    applicable statutes and by general law.
    2. The Participant hereby acknowledges that he/she has full and complete notice and
    understanding of the Act and of all the Risks inherent in equine activities which may cause,
    contribute to or result in the death or personal injury of the Participant or damage to the
    Participant's property (the "Risks"), including, but not limited to: (i)The propensity of an equine to
    behave in dangerous ways, including, but not limited to, kicking, biting, shying and bucking, or to
    trip and/or fall, which may result in injury to the participant; (ii)The inability of anyone whomsoever
    to predict or foresee an equine's reaction to excitement, weather conditions, sound, movements,
    objects, persons, animals, reptiles, birds or insects, and the effects of such reactions; (iii)The
    hazards of surface or subsurface conditions, including, but not limited to, objects or conditions on,
    under or protruding from the surface, both latent and patent; (iv)The hazards which rocks, cliffs,
    hills, fences, trees, stumps, logs, bridges, ditches and other debris and obstacles, and any
    unforeseeably present; (v)The dangers and Risks of tack or harness slipping or breaking for
    whatever reason; (vi)The dangers and Risks of becoming entangled in tack, harness or vehicles
    used in an equine activity; (vii)The Risks of falling from or otherwise becoming unstable on an
    equine or a vehicle used in an equine activity for any reason whatsoever or for no identifiable
    reason; (viii)The dangers and Risks of being struck by an equine, by a rider or by a dog; (ix)Any
    negligent act or omission by the Sponsor/Professional, any Owner or the Equine Activity Sponsor
    which causes or results in the death or personal injury of the Participant or damage to the
    Participant's property; and (x)All other Risks associated with horses, horseback riding and related
    activities.
    3. The Participant hereby RELEASES and WAIVES all rights which he/she may have or hereafter
    have against the Sponsor/Professional, each Owner and the Equine Activity Sponsor for death,
    personal injury or property damage which is in any way associated with the Risks; he/she does
    hereby WAIVE his/her right to sue or to bring any action against the Sponsor/Professional, any
    Owner or the Equine Activity Sponsor in connection therewith; he/she agrees to INDEMNIFY and

    Barnabas Stables, Inc.

    DEFEND the Sponsor/Professional, each Owner and the Equine Activity Sponsor from and to HOLD
    the Sponsor/Professional, each Owner and the Equine Activity Sponsor HARMLESS against any
    such suit or action; and he/she hereby expressly ASSUMES ALL RISKS AND DANGERS of death,
    personal injury and property damage which are in any way associated with the Risks enumerated in
    Paragraph 2 above.
    4. The Participant hereby agrees that he/she shall have the sole individual responsibility for knowing
    the range of his/her own ability to manage, care for and control a particular horse or perform a
    particular equine activity, and that it shall be his/her duty to act within the limits of his/her own
    ability, to maintain reasonable control of the particular horse or horses at all times while
    participating in an equine activity, to heed all posted warnings, to perform equine activities only in
    an area or in facilities designed by the Sponsor/Professional or by the Owner and to refrain from
    acting in a manner which may cause or contribute to the injury of anyone. Furthermore, a
    Participant involved in an accident shall not depart from the area or facility where the equine activity
    took place without leaving personal identification, including name and address, or without notifying
    the proper authorities, or without obtaining assistance when that person knows or reasonably
    should know that any other person involved in the accident is in need of medical or other
    assistance.
    5. The Participant hereby authorizes and consents to any emergency medical care which may at the
    time appear reasonably appropriate under the circumstances as a result of injury or sickness
    caused by or incurred in the course of an equine activity.
    6. This Agreement shall remain valid and in full force and effect from and after the date opposite the
    signature of the Participant until expressly revoked by the Participant in a written notice to the
    Sponsor/Professional.
    7. To the extent possible, this Agreement shall be construed in such manner as will render it, and
    each provision of it, fully enforceable; but if any provision of this Agreement shall be unenforceable,
    such provision (or so much thereof as is unenforceable) shall be deleted and the remainder of this
    Agreement shall continue in full force and effect.
    8. If this Agreement is executed by the undersigned Participant for and on behalf of a minor
    Participant named below, the undersigned Participant hereby warrants and represents that he/she
    is, in fact, the legal parent or guardian of such minor, with full rights of custody and control; that this
    Agreement is given on behalf of and is intended to be binding upon said minor Participant, his heirs,
    personal representatives, successors and assigns; and the undersigned Participant further agrees
    that this Agreement shall also be as fully binding on the undersigned Participant as if it were
    entered into solely on his own behalf.
    9. This Agreement shall be binding upon the heirs, personal representatives, successors and
    assigns of the Participant.
    10. I HAVE FULLY READ AND FULLY UNDERSTAND THE FOREGOING EQUINE LIABILITY RELEASE,
    WAIVER OF RIGHT TO SUE AND ASSUMPTION OF ALL RISKS. I HAVE CONSULTED AND RELIED
    UPON MY OWN ADVISORS ON ALL QUESTIONS IN CONNECTION THEREWITH, AND I HAVE NOT
    RELIED UPON THE SPONSOR/PROFESSIONAL, ANY OWNER OR THE EQUINE ACTIVITY SPONSOR
    FOR ANY ADVICE OR EXPLANATION IN CONNECTION THEREWITH.
    Participant's Name: _______________________________________ Address:
    _________________________________________________ Date: ________________
    Signature
    (To be signed by parent or legal guardian if Participant is under 18 years of age. This signature
    field is considered your official signature.)

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