RELEASE AND HOLD HARMLESS AGREEMENT
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(IF APPLICABLE) Under ____________________ Law, an equine professional is not liable for an injury or death of a participant in equine activities resulting from the inherent risks of equine activities, pursuant to Section ____________________, ____________________.
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NAME: _____________________________________________________ AGE: ____________
ADDRESS: ___________________________________________________________________
CITY/STATE: ________________________________________________ ZIP: _____________
HOME PHONE: _______________________ BUSINESS PHONE: _______________________
ACKNOWLEDGEMENT OF RISK
I, ____________________, acknowledge that I have read the above statements and definitions, and hereby indemnify and hold harmless, ____________________, and its employees or owners from any liability arising from accident, injury, theft, or damages to myself, my representatives, and helpers, all equipment and property, and all animals under my jurisdiction. I have received a copy of ____________________’s Rules and will adhere to them strictly. This agreement shall continue for each and every visit to ____________________’s property.
The terms of this release form shall be construed as the entire agreement and may not be altered, amended, or modified except in writing and signed by both parties. The terms of this release shall be governed by the laws of the State of ____________________.
If under 21, the parent or guardian must read and sign the above, indicting his/her acceptance.
Date: _________ Signed: __________________________
Participant
Date: _________ Signed: __________________________
Parent/guardian (if minor)
GRANT OF PERMISSION
I/we the undersigned, (student/rider above named for, if minor, parents/guardians) hereby grant permission and authority to ____________________, its officers and authorized employees to act for us in executing verbal instructions of if unable to contact us, to act for us in dealing with physicians, available ambulance companies and hospitals, to obtain prompt medical attention for the participant named above in the event of any perceived medical emergency. I hereby covenant and agree to release ____________________, it’s officers, agents and employees, and owners of any property concerned, and hold harmless from liability for any injury or damage which the rider may sustain while at ____________________. Or participating in any activity sponsored by ____________________, and from any liability connected with obtaining prompt medical attention for the rider named above.
Date: _________ Signed: __________________________
Participant
Date: _________ Signed: __________________________
Parent/guardian (if minor)
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