Phone Camper Name * Second Camper Name (If Applicable) Third Camper Name (If Applicable) Parent's Name * Parent's Number * Parent Statement * I hereby state that the rider(s) is/are in good mental and physical health to participate in the activities provided by Sundance Hills Equestrian Center (SHEC), including, but not limited to all aspects of equestrian or horse riding. I am fully aware that any activity involving motion, height or athletic activity creates the possibility of serious injury. I hereby release SHEC, and its employees and volunteers from liability to the above named rider, of the person claiming through him/her, arising from injury to the person or property of the above named rider occurring in the premises of SHEC, including any event sponsored or sanctioned by SHEC, and or travel to and from such activities. ! I understand that SHEC has the right to deny admittance to any student not meeting the standards of the program as it sees fit. I also agree not to hold these parties responsible in the event that my child engages in inappropriate conduct (including, but not limited to disruptive or volatile behavior in our out of camp, etc.) or becomes involved any any activity or with any persons not associated with SHEC, or its scheduled program that SHEC has the right to send him/her home for inappropriate conduct. I further attest that the information contained in this application is correct to the best of my knowledge. In addition, I have agreed to the policy and fee statement and agree to comply. Photo Release * I hereby authorize Sundance Hills Equestrian Center (SHEC) to publish the photographs and videos taken of me and/ or the undersigned minor children, and our names, for use in SHEC’s printed publications, website and training purposes. ! I release SHEC from any expectation of confidentiality for the undersigned minor children and myself and attest that I am the parent or legal guardian of the children listed below and that I have the the authority to authorize SHEC to use their photographs, videos and names. ! I acknowledge that since participation in publications and websites produced by SHEC is voluntary, neither the minor children nor I will receive financial compensation.! I further agree that participation in any publication and website produced by SHEC confers no rights of ownership whatsoever. I release SHEC and its employees and staff from liability for any claims by me or any third party in connection with my participation of the undersigned minor children. Medical Release * You have our permission, in the event of an emergency and in case we are unavailable, to authorize any physician, nurse practitioner or medical personnel to examine, interview, test and if necessary, treat my child as they deem advisable. Doctor's Name Doctor's Number Insurance Company Policy Number Release & Waiver of Liability READ THIS AGREEMENT CAREFULLY BEFORE SIGNING IT. YOUR SIGNATURE INDICATES YOUR UNDERSTANDING OF AND AGREEMENT TO ITS TERMS. BY SIGNING THIS AGREEMENT, YOU (AND YOUR CHILD(REN)) ARE GIVING UP CERTAIN LEGAL RIGHTS, INCLUDING THE RIGHT TO RECOVER DAMAGES IN CASE OF INJURY, DEATH OR PROPERTY DAMAGE FOR ANY REASON INCLUDING, BUT NOT LIMITED TO, THE NEGLIGENCE OF SUNDANCE HILLS EQUESTRIAN CENTER, THE TRAINER, THE STABLE, THE OWNERS, EMPLOYEES AND AGENTS (HEREINAFTER “SHEC”). I and my minor child(ren) (hereinafter the “Undersigned”) in consideration for allowing me (or my minor child(ren)) to handle and ride a horse and on behalf of myself, my child or our personal representatives, heirs, next-of-kin, spouses and assigns, THE UNDERSIGNED HEREBY: 1. Acknowledge that a horse or a mule may, without warning or any apparent cause, buck, stumble, fall, pull back, rear, bite, kick, run, make unpredictable movements, spook, jump obstacles, step on a person’s feet, push or shove a person, saddles or bridles may loosen or break—- all of which may cause the rider to fall or be jolted resulting in serious injury or death to the Undersigned or any person within close proximity of a horse. 2. ACKNOWLEDGE THAT HORSEBACK RIDING, THE HANDLING OF A HORSE OR BEING IN CLOSE PROXIMITY TO A HORSE IS AN INHERENTLY DANGEROUS ACTIVITY AND INVOLVES RISKS THAT MAY CAUSE INJURY AND IN SOME CASES DEATH because of the unpredictable nature and irrational behavior of horses, regardless of training or their past performance. 3. Agrees to wear a safe riding attire including, but not limited to heeled boots, long pants, a long-sleeved shirt and gloves designed for riding when visiting he premises of the stables and an ASTM/SEI certified safety helmet fastened securely under the chin while riding. If Undersigned does not wear these items, Undersigned assumes the increased risk of injury or death associated with failing to wear such protective attire. Undersigned agrees that SHEC has no duty to provide safety attire for Undersigned. a. IT IS RECOMMENDED THAT I, MY CHILD, AND ALL RIDERS WEAR A PROTECTIVE HELMET. IT IS MY UNDERSTANDING THAT A PROTECTIVE HELMET HAS SIGNIFICANT LIFE SAVING PROPERTIES AND IS VALUABLE TOWARDS MY SAFETY. HELMETS ARE MANDATORY FOR ALL RIDERS UNDER THE AGE OF 18. 4. Release SHEC from any and all claims that SHEC were negligent in connection with me or my child(ren) riding a horse, including but not limited to training or selection horses, maintenance, care, fit or adjustment of saddles, or bridles, instruction on riding skills or leading and supervising riders or the use of any equipment provided by SHEC or being on the premises of the stables, which resulted in loss, damage, injury or death. 5. RELEASE, DISCHARGE AND PROMISE NOT TO SUE, INDEMNIFY, SAVE AND HOLD HARMLESS SHEC from and against any loss, liability, injury (including death), damage or cost they may incur arising out of or in any way connected with either me or my child(ren). handling or ding a horse or being in close proximity to a horse or on the premises of the stables or the failure to wear a protective helmet when riding a horse therewith from or contributed to by me or my child(ren)’s own negligence. 6. Agree to abide by and follow any instruction given or rules established by SHEC or any of its employees with regard to me or my child(ren)’s handling or riding a horse or being in close proximity to a horse or on the premises of the stables or the failure to wear a protective helmet when riding a horse. 7. Agrees that the Undersigned has read and understands the following language of section 1542 of the California Civil Code which provides “a general release does not extend to claims which the Creditor does not know or suspect to exist in his favor at the time of executing the release which, if known by him, must have materially affected his settlement with the Debtor.” Having reviewed the provision, the Undersigned nevertheless voluntarily release SHEC from any and all liability claims arising out of the matters set forth herein. The Undersigned understand the word “claims” to include all actions, claims and grievances, whether actual or potential, known or unknown and specifically but non-exclusively, all claims arising out of the matters set forth herein. All claims are forever barred by this release without regard to whether those claims are based on the alleged breach of duty arising under contract or in tort or any claims or cause of action. 8. The Undersigned expressly agrees that the foregoing Release and Waiver of Liability, Assumption of Risk, and Indemnity Agreement is governed by laws of the State of California and is intended to be as broad and inclusive as is permitted by California Law, and that in the event any portion of this Agreement is determined to be invalid illegal, or unenforceable for any reason, the balance of the Agreement shall not be affected or impaired in any way and shall continue in full legal force and effect. 9. Acknowledge that this document is a contract and agree that if a lawsuit is filed against SHEC for any injury or damage in breach of this contract, the Undersigned will pay all attorney’s fees and costs incurred by SHEC in defending such an action. 10. I have read this document. I understand it is a promise not to sue and to release and indemnify SHEC, its owners, employees and agents for any and all claims. I have made a free and deliberate choice to sign the Release and Waiver as a condition to SHEC allowing me and/or my child(ren) to ride or handle a horse. I have concluded that the risks involved and the Release and Waiver of Liability is worth the pleasure of horseback riding and acknowledges that the same is valuable consideration for this Release and Waiver of Liability, Assumption of Risk and Indemnity Agreement. THIS FORM MUST BE SIGNED BY AT LEAST ONE PARENT AS REQUIRED BY CALIFORNIA LAW FOR PERSONS UNDER THE AGE OF 18. Signature (Type Name) * Parent Signature if rider is under 18. Date - Please select. * Message / Comments Share this:Click to share on Facebook (Opens in new window)Click to share on Twitter (Opens in new window)Click to email this to a friend (Opens in new window)