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This liability release form is provided by Camp Cedarbrook to release its future liability during the rider's participation in horse riding activities.
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______ F. CONDITIONS OF NATURE: I understand that this stable is not responsible for total or partial acts,
occurrences, or elements of nature that can scare a horse, cause it to fall, or react in some other unsafe way. Some
examples are: thunder, lightning, rain, wind, water, 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-of-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.
______ G. CARRY-ON OBJECTS AND SHARP NOISES: I understand that riders must not carry loose items on rides
which may fall, blow away, flap in the wind, bounce, or make sharp noises, possibly scaring a horse. Some examples are:
cameras, hats not securely fastened under chin, toys, purses. Riders must not make sharp loud noises such as screaming
or yelling, which may scare a horse.
______ H. SADDLE-GIRTHS NATURAL LOOSENING: I understand that saddle girths (saddle fasteners around horse’s
belly) may loosen during a ride. If a rider notices this he/she must alert the nearest wrangler or instructor as quickly as
possible so action can be taken to avoid slippage the saddle and a potential fall from the animal.
______ I. ACCIDENT / MEDICAL INSURANCE: I agree that should emergency medical treatment be required, I and/or
my own accident / medical insurance company shall pay for all such incurred expenses.
My Accident / Medical Insurance Company is ____________________________________________________________
And my policy number is ________________________________________________
______ J. PROTECTIVE HEADGEAR OFFERING: I, for myself and on behalf of my child and/or legal ward havebeen
offered a SEI certified ASTM Standard F 1163 Equestrian helmet by this stable and do understand that the wearing of
such headgear while mounted, riding, dismounting and otherwise being around horses, may prevent or reduce severity of
some of the wearer’s potential head injuries and possibly prevent the wearer’s death as the result of a fall and/or other
occurrences. It is understood that stable-provided protective headgear may not be of perfect fit for each rider’s head, and
that once provided I/we will be responsible for securing the helmet on this rider’s head at all times. All participants in
CCT horse activities MUST wear a SEI certified helmet in order to participate.
______ K. LIABILITY RELEASE: I agree that in consideration of this stable allowing my participation in this activity,
under the terms set forth herein, I, the rider, for myself and on behalf of my child and/or legal ward, heirs, administrators,
personal representatives or assigns, do agree to hold harmless, release, and discharge this stable, its owners, agents,
employees, officers, directors, representative, assigns, members, owners of premises and trails, affiliated organizations,
insurers, and others acting on its behalf (hereinafter, collectively referred to as “Associates”), from all claims, demands,
causes of action and legal liability, whether the same be known or unknown, anticipated, due to this stable’s gross and
willful negligence, I shall bring no claims, demands, actions and causes of action, and/or litigation against this stable and
its associates as stated above in this clause, for any economic and non-economic losses due to bodily injury, death,
property damage, sustained by me and/or my minor child and/or legal ward in relation to the premises and operations of
this stable, to include while riding, handling, or otherwise being near horses owned by or in the care, custody and control
of this stable, whether on or off the premises of this stable. All riders and parents or legal guardians must sign below
after reading this entire document.
SIGNER STATEMENT OF AWARENESS
I/we the undersigned, have read and do understand the foregoing agreement, warnings, releases and assumption of risk.
I/we further attest that all facts relating to the applicant’s physical condition, experience, and age are true and accurate.
Signature of Rider: _____________________________________________________Date: ____________________
Signature of Parent or Guardian: __________________________________________Date: ____________________
Signature of spouse of Parent or Guardian: __________________________________Date: ____________________
Address in full:_____________________________________________home phone(________)_________________
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