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Release form relating to the 2019 novel coronavirus disease (COVID-19)

 

Coronavirus Disease (COVID-19)

I am aware and understand that any equine related activity ("Activity") is a potentially dangerous activity and involves the risk of serious injury, disability, death, or property damage. I am also aware of the highly contagious nature of bacterial and viral diseases including the 2019 novel coronavirus disease (COVID-19) (the "Disease") and the risk that I may be exposed to or contract the Disease by engaging in the Activity, which may result in serious illness, personal injury, disability, death, or property damage. I acknowledge that these risks may result from or be compounded by the actions, omissions, or negligence of Kilham Farm or Marshall Hall RIding Academy, employees or others, including negligent emergency response or rescue operations of the Company. I understand that while the company has implemented measures to reduce the risk of injury from the Activity and the spread of the Disease, the Company cannot guarantee that I will not be injured or become infected with the Disease due to my participation in the Activity and that engaging in the Activity may increase my risk of contracting the Disease. NOTWITHSTANDING THESE RISKS, I ACKNOWLEDGE THAT I AM VOLUNTARILY PARTICIPATING IN THE ACTIVITY WITH KNOWLEDGE OF THE DANGERS INVOLVED. I HEREBY AGREE TO ACCEPT AND ASSUME ALL RISKS OF INJURY, ILLNESS, DISABILITY, DEATH, OR PROPERTY DAMAGE ARISING FROM MY ENGAGING IN THE ACTIVITY, WHETHER CAUSED BY THE ORDINARY NEGLIGENCE OF THE COMPANY OR OTHERWISE.

 

First Client Name
First Name*
Middle Name
Last Name*
Phone*
First Client Date of Birth*
Date of Birth
First Client Signature*
Second Client Name
First Name*
Middle Name
Last Name*
Client Date of Birth*
Date of Birth
Third Client Name
First Name*
Middle Name
Last Name*
Client Date of Birth*
Date of Birth
Fourth Client Name
First Name*
Middle Name
Last Name*
Client Date of Birth*
Date of Birth
Fifth Client Name
First Name*
Middle Name
Last Name*
Client Date of Birth*
Date of Birth
Sixth Client Name
First Name*
Middle Name
Last Name*
Client Date of Birth*
Date of Birth
Seventh Client Name
First Name*
Middle Name
Last Name*
Client Date of Birth*
Date of Birth
Eighth Client Name
First Name*
Middle Name
Last Name*
Client Date of Birth*
Date of Birth
Ninth Client Name
First Name*
Middle Name
Last Name*
Client Date of Birth*
Date of Birth
Tenth Client Name
First Name*
Middle Name
Last Name*
Client Date of Birth*
Date of Birth
Parent or Guardian's Email Address
Email*
Confirm Email*
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Emergency Contact
First Name*
Last Name*
Emergency Contact's Phone Number*
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*
Middle Name
Last Name*
Phone*
Parent or Guardian's Date of Birth*
Date of Birth
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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