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Haven Acres Program Application 2021
  • 1
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  • 2
    Child must be 9-17 by June 8th.
    Pick a Date
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  • 3
    • American Indian/Alaska Native
    • Asian
    • Black or African American
    • Hispanic/Latino
    • Native Hawaiian/Pacific Islander
    • White
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  • 4
    Please Select
    • Please Select
    • United States
    • Afghanistan
    • Albania
    • Algeria
    • American Samoa
    • Andorra
    • Angola
    • Anguilla
    • Antigua and Barbuda
    • Argentina
    • Armenia
    • Aruba
    • Australia
    • Austria
    • Azerbaijan
    • The Bahamas
    • Bahrain
    • Bangladesh
    • Barbados
    • Belarus
    • Belgium
    • Belize
    • Benin
    • Bermuda
    • Bhutan
    • Bolivia
    • Bosnia and Herzegovina
    • Botswana
    • Brazil
    • Brunei
    • Bulgaria
    • Burkina Faso
    • Burundi
    • Cambodia
    • Cameroon
    • Canada
    • Cape Verde
    • Cayman Islands
    • Central African Republic
    • Chad
    • Chile
    • China
    • Christmas Island
    • Cocos (Keeling) Islands
    • Colombia
    • Comoros
    • Congo
    • Cook Islands
    • Costa Rica
    • Cote d'Ivoire
    • Croatia
    • Cuba
    • Curacao
    • Cyprus
    • Czech Republic
    • Democratic Republic of the Congo
    • Denmark
    • Djibouti
    • Dominica
    • Dominican Republic
    • Ecuador
    • Egypt
    • El Salvador
    • Equatorial Guinea
    • Eritrea
    • Estonia
    • Ethiopia
    • Falkland Islands
    • Faroe Islands
    • Fiji
    • Finland
    • France
    • French Polynesia
    • Gabon
    • The Gambia
    • Georgia
    • Germany
    • Ghana
    • Gibraltar
    • Greece
    • Greenland
    • Grenada
    • Guadeloupe
    • Guam
    • Guatemala
    • Guernsey
    • Guinea
    • Guinea-Bissau
    • Guyana
    • Haiti
    • Honduras
    • Hong Kong
    • Hungary
    • Iceland
    • India
    • Indonesia
    • Iran
    • Iraq
    • Ireland
    • Israel
    • Italy
    • Jamaica
    • Japan
    • Jersey
    • Jordan
    • Kazakhstan
    • Kenya
    • Kiribati
    • North Korea
    • South Korea
    • Kosovo
    • Kuwait
    • Kyrgyzstan
    • Laos
    • Latvia
    • Lebanon
    • Lesotho
    • Liberia
    • Libya
    • Liechtenstein
    • Lithuania
    • Luxembourg
    • Macau
    • Macedonia
    • Madagascar
    • Malawi
    • Malaysia
    • Maldives
    • Mali
    • Malta
    • Marshall Islands
    • Martinique
    • Mauritania
    • Mauritius
    • Mayotte
    • Mexico
    • Micronesia
    • Moldova
    • Monaco
    • Mongolia
    • Montenegro
    • Montserrat
    • Morocco
    • Mozambique
    • Myanmar
    • Nagorno-Karabakh
    • Namibia
    • Nauru
    • Nepal
    • Netherlands
    • Netherlands Antilles
    • New Caledonia
    • New Zealand
    • Nicaragua
    • Niger
    • Nigeria
    • Niue
    • Norfolk Island
    • Turkish Republic of Northern Cyprus
    • Northern Mariana
    • Norway
    • Oman
    • Pakistan
    • Palau
    • Palestine
    • Panama
    • Papua New Guinea
    • Paraguay
    • Peru
    • Philippines
    • Pitcairn Islands
    • Poland
    • Portugal
    • Puerto Rico
    • Qatar
    • Republic of the Congo
    • Romania
    • Russia
    • Rwanda
    • Saint Barthelemy
    • Saint Helena
    • Saint Kitts and Nevis
    • Saint Lucia
    • Saint Martin
    • Saint Pierre and Miquelon
    • Saint Vincent and the Grenadines
    • Samoa
    • San Marino
    • Sao Tome and Principe
    • Saudi Arabia
    • Senegal
    • Serbia
    • Seychelles
    • Sierra Leone
    • Singapore
    • Slovakia
    • Slovenia
    • Solomon Islands
    • Somalia
    • Somaliland
    • South Africa
    • South Ossetia
    • South Sudan
    • Spain
    • Sri Lanka
    • Sudan
    • Suriname
    • Svalbard
    • eSwatini
    • Sweden
    • Switzerland
    • Syria
    • Taiwan
    • Tajikistan
    • Tanzania
    • Thailand
    • Timor-Leste
    • Togo
    • Tokelau
    • Tonga
    • Transnistria Pridnestrovie
    • Trinidad and Tobago
    • Tristan da Cunha
    • Tunisia
    • Turkey
    • Turkmenistan
    • Turks and Caicos Islands
    • Tuvalu
    • Uganda
    • Ukraine
    • United Arab Emirates
    • United Kingdom
    • Uruguay
    • Uzbekistan
    • Vanuatu
    • Vatican City
    • Venezuela
    • Vietnam
    • British Virgin Islands
    • Isle of Man
    • US Virgin Islands
    • Wallis and Futuna
    • Western Sahara
    • Yemen
    • Zambia
    • Zimbabwe
    • Other
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  • 5
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  • 6
    Solely for the purpose of matching the child to an appropriate horse.
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  • 7
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  • 8
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  • 9
    Tuesday evening, Thursday evening, or Friday morning are most likely times that will be available for the regular program.
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  • 10
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  • 11
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  • 12
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  • 13
    Please Select
    • Please Select
    • United States
    • Afghanistan
    • Albania
    • Algeria
    • American Samoa
    • Andorra
    • Angola
    • Anguilla
    • Antigua and Barbuda
    • Argentina
    • Armenia
    • Aruba
    • Australia
    • Austria
    • Azerbaijan
    • The Bahamas
    • Bahrain
    • Bangladesh
    • Barbados
    • Belarus
    • Belgium
    • Belize
    • Benin
    • Bermuda
    • Bhutan
    • Bolivia
    • Bosnia and Herzegovina
    • Botswana
    • Brazil
    • Brunei
    • Bulgaria
    • Burkina Faso
    • Burundi
    • Cambodia
    • Cameroon
    • Canada
    • Cape Verde
    • Cayman Islands
    • Central African Republic
    • Chad
    • Chile
    • China
    • Christmas Island
    • Cocos (Keeling) Islands
    • Colombia
    • Comoros
    • Congo
    • Cook Islands
    • Costa Rica
    • Cote d'Ivoire
    • Croatia
    • Cuba
    • Curacao
    • Cyprus
    • Czech Republic
    • Democratic Republic of the Congo
    • Denmark
    • Djibouti
    • Dominica
    • Dominican Republic
    • Ecuador
    • Egypt
    • El Salvador
    • Equatorial Guinea
    • Eritrea
    • Estonia
    • Ethiopia
    • Falkland Islands
    • Faroe Islands
    • Fiji
    • Finland
    • France
    • French Polynesia
    • Gabon
    • The Gambia
    • Georgia
    • Germany
    • Ghana
    • Gibraltar
    • Greece
    • Greenland
    • Grenada
    • Guadeloupe
    • Guam
    • Guatemala
    • Guernsey
    • Guinea
    • Guinea-Bissau
    • Guyana
    • Haiti
    • Honduras
    • Hong Kong
    • Hungary
    • Iceland
    • India
    • Indonesia
    • Iran
    • Iraq
    • Ireland
    • Israel
    • Italy
    • Jamaica
    • Japan
    • Jersey
    • Jordan
    • Kazakhstan
    • Kenya
    • Kiribati
    • North Korea
    • South Korea
    • Kosovo
    • Kuwait
    • Kyrgyzstan
    • Laos
    • Latvia
    • Lebanon
    • Lesotho
    • Liberia
    • Libya
    • Liechtenstein
    • Lithuania
    • Luxembourg
    • Macau
    • Macedonia
    • Madagascar
    • Malawi
    • Malaysia
    • Maldives
    • Mali
    • Malta
    • Marshall Islands
    • Martinique
    • Mauritania
    • Mauritius
    • Mayotte
    • Mexico
    • Micronesia
    • Moldova
    • Monaco
    • Mongolia
    • Montenegro
    • Montserrat
    • Morocco
    • Mozambique
    • Myanmar
    • Nagorno-Karabakh
    • Namibia
    • Nauru
    • Nepal
    • Netherlands
    • Netherlands Antilles
    • New Caledonia
    • New Zealand
    • Nicaragua
    • Niger
    • Nigeria
    • Niue
    • Norfolk Island
    • Turkish Republic of Northern Cyprus
    • Northern Mariana
    • Norway
    • Oman
    • Pakistan
    • Palau
    • Palestine
    • Panama
    • Papua New Guinea
    • Paraguay
    • Peru
    • Philippines
    • Pitcairn Islands
    • Poland
    • Portugal
    • Puerto Rico
    • Qatar
    • Republic of the Congo
    • Romania
    • Russia
    • Rwanda
    • Saint Barthelemy
    • Saint Helena
    • Saint Kitts and Nevis
    • Saint Lucia
    • Saint Martin
    • Saint Pierre and Miquelon
    • Saint Vincent and the Grenadines
    • Samoa
    • San Marino
    • Sao Tome and Principe
    • Saudi Arabia
    • Senegal
    • Serbia
    • Seychelles
    • Sierra Leone
    • Singapore
    • Slovakia
    • Slovenia
    • Solomon Islands
    • Somalia
    • Somaliland
    • South Africa
    • South Ossetia
    • South Sudan
    • Spain
    • Sri Lanka
    • Sudan
    • Suriname
    • Svalbard
    • eSwatini
    • Sweden
    • Switzerland
    • Syria
    • Taiwan
    • Tajikistan
    • Tanzania
    • Thailand
    • Timor-Leste
    • Togo
    • Tokelau
    • Tonga
    • Transnistria Pridnestrovie
    • Trinidad and Tobago
    • Tristan da Cunha
    • Tunisia
    • Turkey
    • Turkmenistan
    • Turks and Caicos Islands
    • Tuvalu
    • Uganda
    • Ukraine
    • United Arab Emirates
    • United Kingdom
    • Uruguay
    • Uzbekistan
    • Vanuatu
    • Vatican City
    • Venezuela
    • Vietnam
    • British Virgin Islands
    • Isle of Man
    • US Virgin Islands
    • Wallis and Futuna
    • Western Sahara
    • Yemen
    • Zambia
    • Zimbabwe
    • Other
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  • 15
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  • 19
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  • 20
    If yes, please explain.
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  • 21
    Include name of medication, dosage, and frequency.
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  • 22
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  • 24
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  • 25
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  • 26
    If yes, please explain and describe how the child has been instructed to cope with those.
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  • 27
    If yes, please explain.
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  • 28
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  • 29
    The information contained in this application is correct to the best of my knowledge.
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  • 30

    Haven Acres COVID-19 Agreement

    All ranch visitors, volunteers, and staff will be required to do the following:

    • COVID-19 Liability Form: Each participant, volunteer, or family member on the Haven Acres premises must sign a COVID-19 Liability Form in addition to the annual Haven Acres Release of Liability Form. These must be updated at least annually.
    • Regular Monitoring: Each volunteer or participant must do a self-assessment each day prior to arriving at the ranch. (According to the attached COVID-19 symptoms list) If any symptoms are noted personally or in the person’s household, contact the ranch and please remain at home.
    • Temperatures:  Upon arrival to the ranch, your temperature will be checked and documented. If the temperature is 100.4 F or above, you will unfortunately be asked to return home and quarantine for 2 weeks or be able to bring in a negative COVID-19 test signed by a Dr. prior to returning to the ranch.
    • Social Distance: The volunteer/staff member/participant/parent should maintain a 6-foot distance while engaging in activities at Haven Acres except when safety becomes an issue (e.g. volunteer and participant working with a horse). Haven Acres reserves the right to limit the number of volunteers and/or participants at any given time in order to appropriately maintain social distancing standards as recommended by the MN State Governor, the CDC or the WHO. Participants may be accompanied to their session by ONE parent/ family member. We request that parents/family members either remain in their vehicle for the duration of the session or bring their own lawn chair and maintain a 6 foot distance between themselves and other parents, volunteers, and participants. It is preferable that siblings of participants do not come along to the ranch, but if they must, they should remain with the parent at all times and may not sit on benches or play on play equipment while at the ranch in order to reduce the potential for spread of germs.
    • Wear a Mask: Volunteers, participants, and other family members are strongly encouraged to wear masks especially when a distance of 6 feet is not possible. Since it is an outdoor setting, masks are not required if you are able to maintain proper social distancing. Masks do not need to be worn during sessions for deaf and hard of hearing participants. They also are not required if the person has a physical or mental health challenge that would prevent them from doing so.  
    • Disinfect and Clean Workspaces: Shared areas such as offices, bathrooms, common areas, shared tools (manure rakes and shovels), and equipment will be sanitized frequently and after each use (ATV handlebars). Please avoid using other volunteer’s or participant’s phones or manure rakes or other tools. Sanitize or wash your hands prior to using a porous item such as a halter or lead rope. Every item used (grooming supplies or halters and lead ropes…) must be sprayed with disinfectant after use. Avoid touching gates, fencing, etc… as much as possible.
    • Hand Washing:  Frequent handwashing and use of hand sanitizer is necessary. Use hand sanitizer upon arrival and prior to departure from the ranch. Also, please be sure to observe respiratory etiquette such as covering your sneeze or cough EVERY time and washing your hands after blowing your nose. In addition, please avoid touching your eyes, nose, and mouth with your hands as much as possible. Participants will be required to sanitize immediately prior to working with their horse in order to decrease transmission of potentially infectious germs to other volunteers/ participants.
    • Food: Volunteers may bring their own food and consume it in an outdoor space. Hands must be washed before and after eating. Please do not eat while using equipment or tools as that will leave them contaminated.

    If you become sick during the day, you will need to go home immediately and promptly send a list of surfaces and workspaces you were in close proximity to.  We will have them cleaned and disinfected. Be prepared to pass on information of person(s) who you had contact with for the 2 days prior to symptoms. Others at the ranch that have been in close contact during this time would be considered exposed and will need to take additional precautions. If you test positive for Covid-19 these individuals will be asked to seek testing and self-quarantine.

    Symptoms of COVID-19 (CDC):

    • Cough
    • Shortness of breath or difficulty breathing
    • Fever (100.4 degrees F or higher) or feeling feverish
    • Chills
    • Muscle or body aches
    • New Sore throat or headache
    • New loss of taste or smell

    I AGREE TO THESE REQUIREMENTS:

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  • 31

    Waiver of Liability Relating to Coronavirus/COVID-19

    The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is reported to be extremely contagious. The state of medical knowledge is evolving, but the virus is believed to spread from person-to-person contact and/or by contact with contaminated surfaces and objects, and even possibly in the air. People reportedly can be infected and show no symptoms and therefore spread the disease. The exact methods of spread and contraction are unknown, and there is no known treatment, cure, or vaccine for COVID-19. Evidence has shown that COVID-19 can cause serious and potentially life threatening illness and even death.

    Haven Acres cannot prevent you or your child(ren) from becoming exposed to, contracting, or spreading COVID-19 while utilizing Haven Acres’ services or premises. It is not possible to prevent against the presence of the disease. Therefore, if you choose to utilize Haven Acres’ services and/or enter onto Haven Acres’ premises you may be exposing yourself to and/or increasing your risk of contracting or spreading COVID-19.

    ASSUMPTION OF RISK: I have read and understood the above warning concerning COVID-19. I hereby choose to accept the risk of contracting COVID-19 for myself and/or my children in order to utilize Haven Acres’ services and enter Haven Acres’ premises. These services are of such value to me and/or to my children, that I accept the risk of being exposed to, contracting, and/or spreading COVID-19 in order to utilize Haven Acres’ services and premises in person.

    WAIVER OF LAWSUIT/LIABILITY: I hereby forever release and waive my right to bring suit against Haven Acres and its owners, officers, directors, managers, officials, trustees, agents, employees, or other representatives in connection with exposure, infection, and/or spread of COVID-19 related to utilizing Haven Acres’ services and premises. I understand that this waiver means I give up my right to bring any claims including for personal injuries, death, disease or property losses, or any other loss, including but not limited to claims of negligence and give up any claim I may have to seek damages, whether known or unknown, foreseen or unforeseen.

    CHOICE OF LAW: I understand and agree that the law of the State of Minnesota will apply to this contract.

    I HAVE CAREFULLY READ AND FULLY UNDERSTAND ALL PROVISIONS OF THIS RELEASE, AND FREELY AND KNOWINGLY ASSUME THE RISK AND WAIVE MY RIGHTS CONCERNING LIABILITY AS DESCRIBED ABOVE:

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  • 32

    REGISTRATION OF PARTICIPANT AND AGREEMENT PURPOSE

    I, the above listed individual hereinafter known as the "PARTICIPANT", and the parents or legal guardians thereof if a minor, do hereby voluntarily agree to participate in all THIS STABLE activities including horse riding as a student of this THIS STABLE, and that if I ride a horse provided by this THIS STABLE, I will do so for instruction purposes.

    AGREEMENT SCOPE AND TERRITORY AND DEFINITIONS

    This agreement shall be legally binding upon me the registered PARTICIPANT, and the parents or legal guardians thereof if a minor, my heirs, estate, assigns, including all minor children, and personal representatives; and it shall be interpreted according to the laws of the state and county of THIS STABLE’S physical location. This agreement is intended to be valid and binding at all times now and in the future when THIS STABLE permits me (directly or indirectly) to enter THIS STABLE’S property, be on THIS STABLE’S property, be near any horse, receiving riding and/or training instruction or guidance from its associates and/or when I ride and/or train and/or am near horses on or off of THIS STABLE’S property. Any disputes by the PARTICIPANT shall be litigated in, and venue shall be the county in which THIS STABLE is physically located. This agreement is intended to be as broad and inclusive as the law permits. If any clause, phrase or word is in conflict with state law, then that single part is null and void. The term "HORSE" and “EQUINE” herein shall refer to all equine species. The terms “I”, “WE”, “ME, “MY” shall herein refer to the above registered participant and the parents or legal guardians thereof if a minor.

    INHERENT RISKS / ASSUMPTION OF RISKS I/WE ACKNOWLEDGE THAT:

    Risks, conditions, and dangers are inherent in (meaning an integral part of horse/equine/animal activities/stable activities, regardless of all feasible safety measures which can be taken, and I agree to assume them. The inherent risk include, but are not limited to any of the following: The propensity of an animal to behave in ways that may result in injury, harm, death, or loss to persons on or around the animals; the unpredictability of an equine’s reaction to sounds, sudden movement, unfamiliar objects, persons, or other animals; Hazards, including, but not limited to, surface or subsurface conditions; a collision, encounter and/or confrontation with another equine, another animal, a person, or an object; The potential of an equine activity participant to act in a negligent manner that may contribute to injury, harm, death, or loss to the participant or to other persons, including but not limited to, failing to maintain control over and equine and/or failing to act within the ability of the participant. Horses are 5-15 times larger, 20-40 times more powerful, and 3-4 times faster than a human. If a participant falls from horse to ground it will generally be a distance of from 3.5 to 5.5 feet and the impact may result in harm to the participant. Horseback riding and equine training are activities in which one much smaller, weaker predator (the human) tries to impose its will on, and become one unit of movement with, another much larger, stronger prey animal that has a mind of its own (the horse) and each has a limited understanding of the other. If a horse is frightened or provoked it may divert from its training and act according to its natural survival instincts which may include, but are not limited to: Stopping short; Spinning around; Changing directions and/or speed at will; Shifting its weight; Bucking; Rearing; Kicking; Biting and/or Running from danger. I also acknowledge that these are just some of the risk and I agree to assume others not mentioned above. I am not relying on THIS STABLE to list all possible risks for me.

    CONDITIONS OF NATURE WARNING, UNFAMILIAR AND SUDDEN SIGHTS, SOUNDS AND MOVEMENTS WARNING, AND INSPECTION OF PREMISES I/WE AGREE THAT:

    THIS STABLE is NOT responsible for total or partial acts, occurrences, or elements of nature and/or sudden and/or unfamiliar sights, sounds and/or sudden movements that can scare a horse, cause it to fall, or react in some other unsafe way. SOME EXAMPES ARE: Thunder, lightning, rain, wind, wild and domestic animals, insects, reptiles, which may walk, run or fly near, or bite or sting a horse or person; and irregular footing on out-or-door groomed or wild land which is subject to constant change in condition according to weather, temperature, and natural and man-made changes in landscape. I also understand that these are just some of the risks and I agree to assume others mentioned not mentioned above. I am not relying on this stable to list all possible conditions for me. The participant and parent or legal guardian have inspected this STABLE’S facilities and are satisfied that all premise conditions are reasonably safe for this participant’s intended purpose, usage and presence upon THIS STABLE’S premises.

    SADDLE GIRTH/NATURAL LOOSENING I/WE ACKNOWLEDGE THAT:

    Saddle girths (fastener straps around horse's belly) may loosen during riding. Participants must alert the instructor or attendant of any girth looseness so action can be taken to avoid slippage of saddle and the potential for the participant to fall from the horse.

    PROTECTIVE HEADGEAR / HELMET WARNING I / WE AGREE THAT:

    I for myself and on behalf of my child and/or legal ward have been fully warned and advised by THIS STABLE that protective headgear / helmet, which meets or exceeds the quality standards of the SEI CERTIFIED ASTM STANDARD F 1163 Equestrian Helmet, should be worn while riding and/or driving and/or training and/or being near horses, and I understand that the wearing of such headgear/helmet at these times may reduce severity of some of the wearer’s head injuries and possibly prevent the wearer’s death from happening as the result of a fall and other occurrences. I am not relying on THIS STABLE and/or its associates to provide a certified helmet for me or to check any headgear/ helmet or headgear/helmet strap that I may wear, or to monitor my compliance with this suggestion at any time now or in the future.

    EQUINE ACTIVITY LIABILITY ACT (EALA) WARNING OR LANGUAGE:

    I / WE ACKNOWLEDGE THAT: I have reviewed this state’s EQUINE ACTIVITY LIABILITY ACT WARNING OR LANGUAGE, a copy of which is attached hereto, and incorporated as if fully set forth herein. INSTRUCTION TO SIGNERS: DO NOT SIGN UNLESS A COPY OF THE EALA WARNING OR LANGUAGE IS ATTACHED TO THIS AGREEMENT.

    MEDICAL INSURANCE I / WE AGREE THAT: Should medical treatment be required, I and / or my medical insurance company shall pay for ALL such incurred expenses.

    PHOTO RELEASE I/WE RELEASE: release all rights to photos taken of you or the above mentioned for future use by THIS STABLE, its staff, founders, and/or Board of Directors in ranch publications, videos, books, newsletters, etc.

    SAFETY AGREEMENT I/WE AGREE: to stay out of all barns, paddocks, corrals, tack-rooms, and all other related buildings, while waiting for horse related or other activities, or while waiting for a participant.

    LIABILITY RELEASE I / WE AGREE THAT: In consideration of THIS STABLE allowing my participation in this activity, under the terms set forth herein, I, the participant, for myself and on behalf of my child and / or legal ward, heirs, administrators, personal representatives or assigns, do agree to release, hold harmless, and discharge THIS STABLE, its owners, agents, employees, officers, directors, including, but not limited to Jason and Jenifer Heath, Holly Graffunder, Mike and Mary Lubinski, Eddie Zambrano, Jennifer George, Evelyn Jones, Terry Schouweiler, representatives, assigns, members, owners of premises and trails, affiliated organizations, and insurers, and others acting on their behalf (herein after, collectively referred to as “associates”), of and from all claims, demands, causes of action and legal liability, whether the same be known or unknown, anticipated or unanticipated, due to THIS STABLE’S and/or ITS ASSOCIATE’S ordinary negligence or legal liability; and I do further agree that except in the event of THIS STABLE’S gross negligence and/or willful and/or wanton misconduct, I shall not bring any claims, demands, legal actions and causes of action, against THIS STABLE and ITS ASSOCIATES as stated above in this clause, for any economic and noneconomic losses due to bodily injury and / or death and / or property damage, sustained by me and/or my minor child or legal ward in relation to the premises and operations of THIS STABLE, to include while riding, driving, handling, or otherwise being near horses owned by me or owned by THIS STABLE, or in the care, custody or control of THIS STABLE, whether on or off the premises of THIS STABLE, but not limited to being on THIS STABLE’S premises. I am fully aware that there is an element of risk of injury, damage or other misfortune associated with activities on the ranch. I accept the risk of such activities, and undertake them voluntarily.

    All Participants and/or Legal Guardians* must sign below after reading this entire document.

    SIGNER STATEMENT OF AWARENESS

    I / WE, THE UNDERSIGNED, REPRESENT THAT I/ WE HAVE READ AND DO UNDERSTAND THE FOREGOING AGREEMENTS, LIABILILTY RELEASE AND ASSUMPTION OR RISK AGREEMENTS, I / WE UNDERSTAND THAT BY SIGNING THIS DOCUMENT I AM GIVING UP RIGHTS TO SUE TODAY AND IN THE FUTURE. I / WE ATTEST THAT ALL FACTS ARE TRUE AND ACCURATE. I AM SIGNING THIS WHILE OF SOUND MIND AND NOT SUFFERING FROM SHOCK, OR UNDER THE INFLUENCE OF ALCOHOL, DRUGS OR INTOXICANTS.

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  • 33
    Required for anyone 13 years and older
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  • 34
    Pick a Date
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  • 36
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