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Heirloom Acres Farm, LLC
Farm Liability Waiver / Release Form 

Everyone attending an event on the farm is required to complete a waiver. 

I, the undersigned, hereby acknowledge to Heirloom Acres Farm, LLC that:

1. I am actively aware of the risk(s) of participating in a class/activity/flower picking on a farm and working around livestock, which includes goats, cows, horses, chickens, dogs, and any other animal on Heirloom Acres Farm property.

2. I assume all foregoing risk of using Heirloom Acres Farm, LLC property, and accept personal responsibility for damages from my use, including, but not limited to injury, disability, or death.

3. I release, waive, and discharge Heirloom Acres Farm, LLC from any and all liability to me, my heirs, and next of kin for any and all claims, demands, losses, or damages, related to my use of Heirloom Acres Farm property. I agree to accept full responsibility for any guest whom I bring to Heirloom Acres Farm property, and will defend and indemnify Heirloom Acres Farm, LLC against any claim brought by such person. I have read the above waiver and release, understand that I give up substantial rights by signing it, and sign it voluntarily.

 

First Participant's Name

First Name*

Last Name*
First Participant's Age Acknowledgment*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive updates about future events by e-mail
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


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*

Phone*
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
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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