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LIABILITY FORM

ROYAL RIDGES RETREAT - LIABILITY FORM
PARTICIPATION AGREEMENT, RELEASE AND ACKNOWLEDGEMENT OF RISK

In consideration of the services of Royal Ridges Retreat, their agents, owners, officers, volunteers, participants, employees, and all other persons or entities acting in any capacity on their behalf (hereinafter collectively referred to as RRR) I hereby agree to release and discharge RRR, on behalf of myself, my children, my parents, my heirs, assigns, personal representative and estate as follows:

1. I acknowledge that my participation in horseback riding, challenge course, paintball, and other activities led or sponsored by RRR entails known and unanticipated risks which could result in physical or emotional injury, paralysis, death or damage to myself, to property, or to third parties. I understand that such risks simply cannot be eliminated without jeopardizing the essential qualities of the activity. I further understand that RRR programs and activities are based on the participation by choice and challenge by choice principles. At any time I and/or my group are free to withdraw from participation in the activity and its potential for the risks involved.

The risks include, but are not limited to:slips, falls and falling; rope burns; pinches, scrapes, bruises, twists and jolts that could result in scratches, bruises, sprains, lacerations, fractures, concussions, or even more severe life threatening hazards. During an activity, there may be contact with plants, animals, or insects that could create hazards such as kicks, bites, stings, allergies, and associated disease. Furthermore, RRR Staff Members have difficult jobs to perform. They seek safety, but they are not infallible. They might be unaware of participants emotional stability, ability to handle stressful situation, physical fitness or abilities; they might misjudge the weather, and horses, which by their very nature are unpredictable.

2. I expressly agree and promise to accept and assume all risks existing in the activity. My participation in any activity sponsored by RRR is purely voluntary, and I elect to participate in spite of the risks.

3. I hereby voluntarily release, forever discharge and agree to indemnify, and to hold harmless RRR from any and all claims, demands or causes of action; which are in any way connected with participation in any activity, or my use of RRRs equipment or facilities, including any such claims which allege negligent acts or omissions of RRR.

4. Should RRR, or anyone acting on their behalf, be required to incur attorneys fees and costs to enforce this agreement, I agree to indemnify and hold them harmless for all such fees and costs.

5. I certify that I have adequate insurance to cover any injury or damage I may cause or suffer while participating, or in the alternative, I agree to bear the costs of such injury or damage to myself. I further certify that I have no medical or physical conditions, which would interfere with my safety in this activity; therefore, I am willing to assumeand bear the cost ofall risks that may be created, directly or indirectly by any such condition.

6. In the event that I file a lawsuit against RRR, I agree to do so solely in the state of Washington; and I further agree, that the substantive law of that state shall apply in that action without regard to the conflict of law rules of that state.

By signing this document, I acknowledge that if anyone is hurt or property is damaged during my participation in any RRR activity, I may be found by a court of law to have waived my right to maintain a lawsuit against RRR on the basis of any claim from which I have released them herein.

 

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information
PICTURE RELEASE: I authorize use of photos or video taken of my child for promotional purposes. I have had sufficient opportunity to read this entire document. I have read and understand it, and agree to be bound by its terms.*
No
Yes
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Information
PICTURE RELEASE: I authorize use of photos or video taken of my child for promotional purposes. I have had sufficient opportunity to read this entire document. I have read and understand it, and agree to be bound by its terms.*
No
Yes
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Information
PICTURE RELEASE: I authorize use of photos or video taken of my child for promotional purposes. I have had sufficient opportunity to read this entire document. I have read and understand it, and agree to be bound by its terms.*
No
Yes
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information
PICTURE RELEASE: I authorize use of photos or video taken of my child for promotional purposes. I have had sufficient opportunity to read this entire document. I have read and understand it, and agree to be bound by its terms.*
No
Yes
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information
PICTURE RELEASE: I authorize use of photos or video taken of my child for promotional purposes. I have had sufficient opportunity to read this entire document. I have read and understand it, and agree to be bound by its terms.*
No
Yes
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information
PICTURE RELEASE: I authorize use of photos or video taken of my child for promotional purposes. I have had sufficient opportunity to read this entire document. I have read and understand it, and agree to be bound by its terms.*
No
Yes
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information
PICTURE RELEASE: I authorize use of photos or video taken of my child for promotional purposes. I have had sufficient opportunity to read this entire document. I have read and understand it, and agree to be bound by its terms.*
No
Yes
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information
PICTURE RELEASE: I authorize use of photos or video taken of my child for promotional purposes. I have had sufficient opportunity to read this entire document. I have read and understand it, and agree to be bound by its terms.*
No
Yes
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information
PICTURE RELEASE: I authorize use of photos or video taken of my child for promotional purposes. I have had sufficient opportunity to read this entire document. I have read and understand it, and agree to be bound by its terms.*
No
Yes
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information
PICTURE RELEASE: I authorize use of photos or video taken of my child for promotional purposes. I have had sufficient opportunity to read this entire document. I have read and understand it, and agree to be bound by its terms.*
No
Yes
Parent or Guardian's Email Address

Email
A signed copy of this waiver will be sent to the email address you provide.
Dietary Needs/Allergies: Leave empty if NO
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.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information
PICTURE RELEASE: I authorize use of photos or video taken of my child for promotional purposes. I have had sufficient opportunity to read this entire document. I have read and understand it, and agree to be bound by its terms.*
No
Yes
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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