MEDICAL AUTHORIZATION FORM
This Medical Authorization Form ("this Agreement") is hereby given by (i) the Counselor, Equine Specialist, or Facilitator (in each case, the "sponsor") (ii) as agents for and for the benefit of each owner of land upon which an equine activity to which this Agreement relates is conducted ("owner"), and (iii) to each partner, officer, agent, employee, subscriber, member, heir, personal representataive, successor as assign of sponsor and of each owner (who shall be included within the words "sponsor" or "owner" as their relationship may determine) and provides as follows: In consideration of the opportunities provided by the sponsor and each owner to the undersigned (including any minor in whose behalf the undersigned signs this Agreement) (the "participant") for the enjoyment of equine activities as participant, the participant, including any monor participant for whom he signs this Agreement , hereby agrees as follows:
We the undersigned hereby authorize Isaiah's Place Inc. to authorize any and all medical treatment they, in their discretion, see fit. This includes, but not limited to treatment to relieve pain. A photocopy of this authorization shall be deemed effective as if it were an original. This authorization 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 personally delivered to the sponsor.