Loading...

Wings of Hope Ranch

One Day / Work Day Waiver Only

*and COVID-19 Waiver* 

RELEASE OF LIABILITY AND HOLD HARMLESS AGREEMENT

The undersigned participant, and his or her parent or legal guardian if the participant is under the age of 18 years old, is aware that equine activities in which the participant may directly or indirectly engage, whether mounted or un-mounted, to include but not be limited to: horseback riding, training, driving, jumping or otherwise being a passenger upon an equine; and also handling, leading, grooming and otherwise attending to the equine, are activities and events which pose potentially serious risks of injuries or death to the participants. I understand that the participant may be injured or die as a result of the participant's negligence, the negligence of others, or through no fault of the participant or anyone else but because of the nature of the activity in which the participant is going to be engaged.  I also understand that horses, even the most well-trained, are unpredictable and may be difficult to control.

With this waiver,  I accept notice of the provisions of the Equine Activity Liability Act, Sections 3.2-6200 through 3.2-6203 of the Code of Virginia, 1950, as amended, which state in part, the intrinsic dangers or conditions that are an integral part of equine activities, including but not limited to (i) the propensity of an equine to behave in ways that may result in injury, harm or death to persons on or around them; (ii) the unpredictability of an equine's reaction to sounds, sudden movements, and unfamiliar objects, persons or other animals; (iii) certain hazards such as surface and subsurface conditions; (iv) collisions with other animals or objects; and (v) the potential of a participant acting in a negligent manner that may contribute to injury to the participant or others, such as failing to maintain control over the equine or not acting within the participant's ability. This waiver shall remain valid unless expressly revoked by me, or if a minor, by a parent or guardian, in writing, with receipt acknowledged in writing by an agent/director of the Wings of Hope Ranch.

Furthermore, with this waiver, I expressly assume the risk of injury or death due to the ordinary negligence of the Wings of Hope Ranch, located at 14505 West Patrick Henry Rd, Montpelier, VA 23192 and any and all of its employees, agents, volunteers, and representatives, However, I understand that this release is not intended to prevent or limit liability in the event of gross negligence or willful misconduct by any of the aforementioned parties.

With knowledge of the foregoing, and as an inducement for the participant's ability to participate in equine activities at the Wings of Hope Ranch, I hereby agree to waive and release any and all rights that I or my heirs may have to make a claim against the Wings of Hope Ranch and all its agents, employees, representatives and volunteers, arising from any damages, injury or death which the participant might sustain while engaging in equine activities at the Wings of Hope Ranch.  I further agree to indemnify and hold harmless the Wings of Hope Ranch, its agents, representatives and volunteers from any claims which I might make or which might be made on my behalf by others or which might be made against the Wings of Hope Ranch by others, arising from the participant's equine activities at the Wings of Hope Ranch.  Furthermore, I agree to indemnify the Wings of Hope Ranch for any injury, death, loss or damage to any personal property when such injury, death, loss or damage arises from the participant's equine activities at the Wings of Hope Ranch or at an event hosted by the Wings of Hope Ranch.

BY SIGNING THIS WAIVER AND RELEASE, I UNDERSTAND THAT I AM GIVING UP, WAIVING AND RELEASING, ANY RIGHT I MIGHT HAVE TO SUE OR MAKE A CLAIM AGAINST THE WINGS OF HOPE RANCH AND ANY OF ITS AGENTS, EMPLOYEES, VOLUNTEERS OR REPRESENTATIVES, FOR ANY INJURIES THE PARTICIPANT MIGHT SUSTAIN TO ITS PERSON OR ITS PERSONAL PROPERTY, WHILE HORSEBACK RIDING OR OTHERWISE PARTICIPATING, EITHER DIRECTLY OR INDIRECTLY, MOUNTED OR UNMOUNTED, IN AN EQUINE ACTIVITY AT THE WINGS OF HOPE RANCH, AND THAT I AM INDEMNIFYING AND HOLDING HARMLESS,  THE WINGS OF HOPE RANCH AND ALL OF ITS EMPLOYEES, AGENTS, VOLUNTEERS OR REPRESENTATIVES,  FOR INJURIES TO ANYONE ELSE OR ANY HORSE RIDDEN BY ANOTHER WHILE I AM ENGAGED IN EQUINE ACTIVITIES AT THE WINGS OF HOPE RANCH.  IT IS MY INTENT TO GIVE UP THOSE RIGHTS AND PROVIDE THIS HOLD HARMLESS AGREEMENT AND I DO SO KNOWINGLY AND VOLUNTARILY.

Wings of Hope Ranch COVID-19 Waiver

Anyone who is planning on coming to Wings of Hope Ranch is required to be aware of and agree to our current COVID-19 policies as follows:  

I understand the uncertainties we as a society currently face as a result of the novel coronavirus (COVID-19), and therefore assume the risk of exposure by participating in events at Wings of Hope Ranch. I further understand that the staff and team members of Wings of Hope Ranch will do everything possible to mitigate the spread of COVID-19, however, there are no assurances that these steps are a guarantee against infection.

By signing this waiver I acknowledge that the staff and leaders at the Ranch will do their part in following the guidelines as established by local, state, and federal agencies, as well as guidelines established by the Ranch, to help prevent the spread of COVID-19. I also acknowledge that I will do my part in ensuring the safety of myself and others while at the Ranch.

COVID-19 Wings of Hope Ranch Safety Protocols / Effective as of 07/2020

These protocols are based on CDC recommendations and are subject to change as we move through various stages of reopening per Virginia regulations or if more stringent guidelines are put in place due to a second wave of the virus.

Hand sanitizer will be available and required before beginning any activity at the barn. 

1. Social distancing of 6 feet minimum should be maintained at all times unless safety is a concern (think double arm’s length). 10 feet is strongly recommended if possible. This will be facilitated in sessions in the following way:

                           Tacking up of horses will take place in the outdoor paddock instead of the stalls to allow for volunteer/rancher distancing
                           The Bible devotional time will take place outside in the riding ring rather than at the table in the shed to allow for distancing

2.  Masks must be worn if more than 2 people are at the ranch working together. (If you do not have your own mask, we will provide one reusable bandana to you. These will be available at the "cleaning station" which will be set up in the barn for you. Please take one if needed, keep it for use at the ranch and wash after each use). Bandanas and masks must be worn over the mouth and nose when interacting with others and standing within 10 feet of each other. Please avoid touching it as much as possible. These masks can be taken down off of nose and mouth when you are more than 10 feet away from the next person, say in riding ring or separate stalls grooming etc.

3.  Grooming buckets, helmets and boots: Please spray each item, grooming tool and bag with Lysol after each use. Sessions will be shortened to allow a 15 minute time period between sessions to clean and disinfect these items

4.  Lead ropes/halters: Please limit your touching of many lead ropes and halters. For example, if you are there doing barn chores, use the largest halter to move all the horses in or out of the barn and spray with Lysol after your are finished with it. If you are there working with a specific horse, spray the lead rope and halter with Lysol when finished with it.

5. Groups that ride, work horses in riding ring, or meet in small groups at ranch: If you use bridles, saddles and pads, you can leave them on the benches in the sunshine outside the shed and the evening barn help will put them away. If it is supposed to rain, please spray each item with Lysol before putting away in shed. Supervisor will be responsible wiping down feed room door and stall latches after everyone is gone by spraying with Lysol. Gates, chains and tack will be naturally disinfected by the sunshine. 

Illness Policy During Covid-19
We have to remember that the Ranch is a public place and that we’re not only responsible for ourselves, but for others. Some of our ranchers or volunteers may have compromised immune systems.
You are not to come to the ranch if you are experiencing any of the following Covid-19 symptoms (as described in CDC guidelines as of May 7, 2020): cough, shortness of breath or difficulty breathing, fever (100.4+), chills, muscle pain, sore throat, loss of taste or smell.

If you are diagnosed with Covid-19 or anyone in your immediate household is diagnosed with Covid-19 you are to please notify Alison Boyd immediately via phone (804) 397-0469. This will allow us to inform anyone who has been in contact and appropriate measures can be taken to help mitigate its spread.  

If you contract COVID-19 you will not be allowed to return to the ranch until 2 weeks after any of the symptoms listed above resolve or 72 hours after a negative Covid-19 test.   

If you have COVID-19 exposure without PPE we ask you not to return to the ranch for 2 weeks after your exposure.  

If any of these scenarios apply to you, and you cannot complete an assigned shift at the ranch, please contact Kennedy Hall (804) 839-3955, if you are a barn volunteer OR your session supervisor if you are a session volunteer to find a substitute for your shift(s).  

 

Today's Date: December 4, 2020

First Volunteer Name

First Name*

Last Name*

Phone*
First Volunteer Date of Birth*
First Volunteer Information

The DATE you are coming to Wings of Hope. *

Click to customize text


Wings of Hope Volunteer or Group you are coming with. *

Parent/Guardian, if you're not a biological parent of the minor, please provide the COURT JURISDICTION which granted you legal custody of the minor(s) and the DATE legal custody granted.
First Volunteer Signature*
Second Volunteer Name

First Name*

Last Name*

Phone*
Second Volunteer Date of Birth*
Second Volunteer Information

The DATE you are coming to Wings of Hope. *

Click to customize text


Wings of Hope Volunteer or Group you are coming with. *

Parent/Guardian, if you're not a biological parent of the minor, please provide the COURT JURISDICTION which granted you legal custody of the minor(s) and the DATE legal custody granted.
Third Volunteer Name

First Name*

Last Name*

Phone*
Third Volunteer Date of Birth*
Third Volunteer Information

The DATE you are coming to Wings of Hope. *

Click to customize text


Wings of Hope Volunteer or Group you are coming with. *

Parent/Guardian, if you're not a biological parent of the minor, please provide the COURT JURISDICTION which granted you legal custody of the minor(s) and the DATE legal custody granted.
Fourth Volunteer Name

First Name*

Last Name*

Phone*
Fourth Volunteer Date of Birth*
Fourth Volunteer Information

The DATE you are coming to Wings of Hope. *

Click to customize text


Wings of Hope Volunteer or Group you are coming with. *

Parent/Guardian, if you're not a biological parent of the minor, please provide the COURT JURISDICTION which granted you legal custody of the minor(s) and the DATE legal custody granted.
Fifth Volunteer Name

First Name*

Last Name*

Phone*
Fifth Volunteer Date of Birth*
Fifth Volunteer Information

The DATE you are coming to Wings of Hope. *

Click to customize text


Wings of Hope Volunteer or Group you are coming with. *

Parent/Guardian, if you're not a biological parent of the minor, please provide the COURT JURISDICTION which granted you legal custody of the minor(s) and the DATE legal custody granted.
Sixth Volunteer Name

First Name*

Last Name*

Phone*
Sixth Volunteer Date of Birth*
Sixth Volunteer Information

The DATE you are coming to Wings of Hope. *

Click to customize text


Wings of Hope Volunteer or Group you are coming with. *

Parent/Guardian, if you're not a biological parent of the minor, please provide the COURT JURISDICTION which granted you legal custody of the minor(s) and the DATE legal custody granted.
Seventh Volunteer Name

First Name*

Last Name*

Phone*
Seventh Volunteer Date of Birth*
Seventh Volunteer Information

The DATE you are coming to Wings of Hope. *

Click to customize text


Wings of Hope Volunteer or Group you are coming with. *

Parent/Guardian, if you're not a biological parent of the minor, please provide the COURT JURISDICTION which granted you legal custody of the minor(s) and the DATE legal custody granted.
Eighth Volunteer Name

First Name*

Last Name*

Phone*
Eighth Volunteer Date of Birth*
Eighth Volunteer Information

The DATE you are coming to Wings of Hope. *

Click to customize text


Wings of Hope Volunteer or Group you are coming with. *

Parent/Guardian, if you're not a biological parent of the minor, please provide the COURT JURISDICTION which granted you legal custody of the minor(s) and the DATE legal custody granted.
Ninth Volunteer Name

First Name*

Last Name*

Phone*
Ninth Volunteer Date of Birth*
Ninth Volunteer Information

The DATE you are coming to Wings of Hope. *

Click to customize text


Wings of Hope Volunteer or Group you are coming with. *

Parent/Guardian, if you're not a biological parent of the minor, please provide the COURT JURISDICTION which granted you legal custody of the minor(s) and the DATE legal custody granted.
Tenth Volunteer Name

First Name*

Last Name*

Phone*
Tenth Volunteer Date of Birth*
Tenth Volunteer Information

The DATE you are coming to Wings of Hope. *

Click to customize text


Wings of Hope Volunteer or Group you are coming with. *

Parent/Guardian, if you're not a biological parent of the minor, please provide the COURT JURISDICTION which granted you legal custody of the minor(s) and the DATE legal custody granted.
Volunteer 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*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
I/We am/are the parent(s) or guardian of a minor, and on the minor's behalf and on my/our own behalf as the parent or guardian of the minor, I/we accept the release and waiver of liability contained within this form as an inducement for allowing my/our child, or this minor, to participate in equine activities which may occur at Wings of Hope Ranch. I/We have carefully read and understand the provisions as stated above, particularly, the INTRINSIC DANGERS associated with all equine activities. I/We further authorize emergency medical care which may be necessary. I/We represent and warrant that I/we have the legal authority to give this release.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

The DATE you are coming to Wings of Hope. *

Click to customize text


Wings of Hope Volunteer or Group you are coming with. *

Parent/Guardian, if you're not a biological parent of the minor, please provide the COURT JURISDICTION which granted you legal custody of the minor(s) and the DATE legal custody granted.
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.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver - TRY IT FREE!