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PLEASE READ CAREFULY BEFORE SIGNING

Serious injury may result from your participation in this activity.
Mariposa Farms does not guarantee your safety or that of your horses.

WARNING: Under Georgia Law, an equine activity sponsor or equine professional is not liable for an injury or death of a participant in equine activities resulting from inherent risks of equine activities, pursuant to Chapter 12 of Title 4 of the Official Code of Georgia Annotated.

Considering Mariposa Farms, Bethany Butler, their officers and family members, agents, employees, residents and contractors (hereinafter referred to as Mariposa), I agree to indemnify, hold harmless, and release Mariposa from and against all liability whatsoever, and agree not to bring suit against Mariposa on account of, or in connection with, any claims, cause of loss, action, injury, damage, cost or expense, or loss to myself, my horse, my family, guests or other, by an act or omission of Mariposa; also from and against all risks of using the facilities at Mariposa, riding horses on or off the property of Mariposa, and boarding horses with Mariposa. I acknowledge and understand that I ride at my own risk and accept full responsibility for the safety of myself, my family and my guests at Mariposa.

I have inspected Mariposa’s facilities and am satisfied that all premises conditions are reasonably safe for my intended purpose and use. I am aware of Mariposa’s boundaries and this agreement only pertains to activities on property owned by Mariposa. Activities off Mariposa property are at the risk of rider and are not endorsed by Mariposa.

I agree that for myself, and on behalf of any guest I bring, Mariposa has advised that protective headgear which meets or exceeds quality standards of the SEI Certified ASTM Standard F1163 equestrian helmet, should be worn while riding and being near horses. I do understand that wearing of such headgear at these times may reduce the severity of some of the wearer’s head injuries and possibly prevent the wearer’s death from happening as a result of a fall or other occurrence. All riders under the age of 18 must, per rules of Mariposa, wear such helmet whenever mounted.

Mariposa has my permission to use their judgment with regard to my treatment, or my horse’s treatment in event of an emergency. Should emergency medical treatment be required for me or my horse, I agree to pay all incurred expenses.

Today's Date: August 26, 2019

First Participant's Name

First Name*

Last Name*

Phone*
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*
Participant's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
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Parent or Guardian's Email Address

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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*
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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