ACKNOWLEDGMENT of RISK and RELEASE of LIABILITY

Participant & Guardian (if Participant is under 18) Information

Participant's Name:

First NameLast Name

Date of Birth:

Date

Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Medical and Other Conditions Disclosure

The undersigned participant acknowledges that disclosing any pre-existing medical, physical, mental health, or cognitive conditions, injuries, allergies, or other concerns that may affect their ability to safely participate in activities at Artillery Equestrian is important for their safety and the safety of others. The participant further understands that failure to provide such information may increase the risk of injury to themselves or others and agrees to inform the HOST of any such conditions prior to participation. All information provided will be kept confidential between the HOST'S staff.

Do you/ the participant have any pre-existing medical, physical, mental health, cognitive or developmental conditions, injuries, allergies, or other concerns that the HOST should be aware of that may affect your ability to safely participate in equine activities?

Please Indicate Medical/ Other Conditions if Indicated "Yes" Above

Guardian's Name (if Participant is under 18):

First NameLast Name

Guardian's Address (if Applicable & different than Participant):

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Participant (or Guardian if Applicable) Phone Number

Please enter a valid phone number

Is this a cellphone or a landline?

Participant (or Guardian if Applicable) Email

example@example.com

Emergency Contact Information

Emergency Contact (18+)

First NameLast Name

Relationship to Participant

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Every Person must Read and Understand this form before Participating in Equine Activities

TO: Artillery Equestrian/Alicia Chaulk their directors, employees, officers, volunteers, business operators, and site property owners. (all of them collectively called the HOST) as well as Ontario Equestrian, Equestrian Canada and their affiliates.

Initial each item below After Reading and Understanding the item - If Under 18 a Guardian must Initial

1. I Understand there are Inherent DANGERS, HAZARDS and RISKS, (collectively called RISKS) associated with Equine Activities and injuries resulting from these "RISKS" are a common occurrence.

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2. I Acknowledge that the Inherent "RISKS" of Equine Activities mean those DANGEROUS conditions which are an integral part of Equine Activities, including but not limited to:

The propensity of any equine to behave in ways that might result in injury, harm or death to persons on or around them and to potentially collide with, bite or kick other animals, people, or objects.
The unpredictability of an equine's reaction to such things as sounds, sudden movement, tremors, vibrations, unfamiliar objects, persons or other animals and hazards such as subsurface objects.
The potential for other participant (s) to act in a negligent manner that might contribute to injury to themselves or others, such as failing to act within their ability or to maintain control over an equine.

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3. I Freely Accept and Fully Assume All Responsibility for the Inherent "RISKS" and the possibility of personal injury, death, property damage or loss resulting from my/my child's Participation in Equine Activities.

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4. I Acknowledge that it remains my Sole Responsibility to act in such a manner as to be responsible for my own safety and to Participate Within My Own Limits. I agree to wear an ASTM certified helmet while mounted AT ALL TIMES as well as boots with a 1" heel while on the property.

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5. In addition to consideration given for my Participate in Equine Activity, I and my heirs, executors, administrators and assigns (collectively called my "Legal Representatives") agree

To Waive All Claims that I might have against the "HOST"; and
To Release the "HOST" from Any and All Liability for any loss, damages, injury, or expense that I or my child or "Legal Representatives" might suffer as a result of my or my child's Participation due to any cause whatsoever including any NEGLIGENCE ON THE PART OF THE "HOST"; and
TO HOLD HARMLESS AND INDEMNIFY THE "HOST" from any and all liability for property damage or personal injury to any third party which might result from my Participation in Equine Activities.

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6. I Acknowledge the HOST is not responsible for any slips, trips, or falls that may occur on the property. All individuals enter and use the facility at their own risk and are expected to exercise caution at all times

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7. I Acknowledge & Accept that I am Solely Responsible for any guests or visitors I may bring to the HOST's property, whether minor or adult. I further accept to ensure guests follow all facility rules and safety guidelines at all times. The HOST reserves the right to ask any guest to leave the property if policies are not being respected.

Initial

Before signing this form I read it (as indicated by my initials above) and I stated that I understand it. I know that signing this form, waives certain legal rights I or my "Legal Representatives" might have against the "HOST".

Do Not Sign Until You Understand All Items Above

Print Name of Participant or Guardian Initialing & Signing

(Signature of Participant or Guardian if Participant is under 18)

(Print Name of Witness to Signing & Initialing - Must be Over 18 & Different than Individual Above)

(Signature of Witness)

Date Signed

Date