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Liability Waiver, Assumption of Risk, Photo Release and Disclosure of Personal Information Agreement


At Heart Lake Farm, we care deeply about creating a safe, respectful, and meaningful environment for both people and animals. Spending time on a working farm and with animals can be incredibly rewarding, and it also comes with some natural risks.

The information below is here to help you understand those risks and the shared responsibility we all have in keeping everyone safe. Please take a moment to read through it carefully.

To owners of Heart Lake Farm, Jessica and Scott Lake, as well as their employees and representatives, hereinafter referred to as “HLF,” for all educational and leisure activities, horse related care, horseback riding and other equestrian activities at 6207 and 6215 Welch Rd., Saanichton BC, V8M 1W7. This includes, but is not limited to, services provided at Heart Lake Farm by the following individuals and organizations: Together in Stride, Human-Nature Counselling Society, Victoria Therapeutic Riding Association, Lisa Hartwick, Kimberley Andersen and Kirsten Duncan.

I understand that Heart Lake Farm is a working farm, which means there are natural risks present. These may include uneven or varied terrain, bodies of water, equipment and machinery, as well as wild animals and livestock. I agree to follow all rules and directions, use common sense, and act with awareness of my own physical abilities and limitations. I also understand that I am choosing to take part in Heart Lake Farm’s educational, therapeutic, and leisure activities at my own risk.


I understand that horse care, groundwork, horseback riding, and other equestrian activities are considered high-risk activities. I am choosing to participate in these activities at my own risk, and I am fully aware of the potential hazards that naturally come with interacting with horses.


I also understand that interacting with all farm animals involves inherent risks. This includes the possibility of bodily injury to people when in the presence of horses, which can happen even during normal use, care, and training.


In consideration of being allowed to participate in educational, therapeutic, and leisure activities, as well as animal care, horseback riding, and other equestrian activities at 6207 and 6215 Welch Road, I accept full responsibility for all risks. I hereby release HLF from any responsibility, liability, or claims of any kind that may arise from my participation; this includes, but is not limited to, bodily injury or death to myself, any minors in my care, my animal as well as any damage to property, regardless of the cause, including negligence on the part of HLF.


I understand that this agreement, and any rights, duties, and obligations between the parties, will be governed and interpreted solely under the laws of the Province of British Columbia. Any legal action related to this agreement must be brought within the Province of British Columbia and will fall under the exclusive jurisdiction of the Courts of British Columbia.


By signing this agreement, I confirm that I have read, fully understood, and agree to all of the terms and conditions outlined above. I understand that this agreement is binding on me, as well as my executors, heirs, and assigns.  


Today's Date: May 19, 2026

First Participants Name
First Name*
Last Name*
Phone*
First Participants Age Acknowledgment*
First Participants Date of Birth*
Date of Birth
I certify that I am 18 years of age or older
First Participants Information
Preferred Pronouns:
Preferred Name:
First Participants Signature*
Second Participants Name
First Name*
Last Name*
Participants Date of Birth*
Date of Birth
Information
Preferred Pronouns:
Preferred Name:
Third Participants Name
First Name*
Last Name*
Participants Date of Birth*
Date of Birth
Information
Preferred Pronouns:
Preferred Name:
Fourth Participants Name
First Name*
Last Name*
Participants Date of Birth*
Date of Birth
Information
Preferred Pronouns:
Preferred Name:
Fifth Participants Name
First Name*
Last Name*
Participants Date of Birth*
Date of Birth
Information
Preferred Pronouns:
Preferred Name:
Sixth Participants Name
First Name*
Last Name*
Participants Date of Birth*
Date of Birth
Information
Preferred Pronouns:
Preferred Name:
Seventh Participants Name
First Name*
Last Name*
Participants Date of Birth*
Date of Birth
Information
Preferred Pronouns:
Preferred Name:
Eighth Participants Name
First Name*
Last Name*
Participants Date of Birth*
Date of Birth
Information
Preferred Pronouns:
Preferred Name:
Ninth Participants Name
First Name*
Last Name*
Participants Date of Birth*
Date of Birth
Information
Preferred Pronouns:
Preferred Name:
Tenth Participants Name
First Name*
Last Name*
Participants Date of Birth*
Date of Birth
Information
Preferred Pronouns:
Preferred Name:
Participants Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address
Email*
Your signed waiver will be sent to the email address provided here and is available for download for three days via URL attachment.
Emergency Contact
First Name*
Last Name*
Emergency Contact's Phone Number*
Participants Consent
PHOTOGRAPH AND VIDEO RELEASE CONSENT: I give permission to Heart Lake Farm owners, staff and associates to photograph/video me and use such photograph(s)/video(s) in all forms of media, for any and all promotional purposes including advertising, display, audiovisual, exhibition or editorial use. I understand that no payment or compensation will be provided. My name will not be used without separate prior consent in specific cases.*
Yes this is fine with me
No, I prefer not to be photographed
CONSENT TO SHARING OF PERSONAL INFORMATION: I understand that the information I have provided in this document, and in any communication and forms regarding registration or appointment booking, as well as information I provide or observations made of my activities during my time at the farm, may be shared among staff of Heart Lake Farm for the purpose of program delivery, professional development or emergency response. Identifying information will never be shared with anyone outside of farm staff for any reason, except in the case of a medical emergency where I cannot speak for myself.*
Yes this is fine with me
No - please contact eva@heartlakefarm.ca to discuss
As parent/guardian of Minor I acknowledge that I have read and fully understand and agree to the terms and conditions stated herein on behalf of Minor and myself.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name
First Name*
Last Name*
Relationship*
Phone*
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
Date of Birth
I certify that I am 18 years of age or older
Parent or Guardian's Information
Preferred Pronouns:
Preferred Name:
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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