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Equine Escapes Liability Release Form

This form must be completed by and for each participant.

Please read carefully before signing.

SERIOUS INJURY MAY RESULT FROM YOUR PARTICIPATION IN THIS ACTIVITY. THIS FACILITY AND/OR ANY INSTRUCTOR/GUIDE CONNECTED WITH IT DOES NOT GUARANTEE YOUR SAFETY OR THAT OF ANY HORSE
In consideration for participating in horse-related activities, Training or instruction connected with EQUINE ESCAPES, the undersigned hereby agrees as follows:

A. REGISTRATION OF RIDER AND PURPOSE OF AGREEMENT: I, the following listed individual hereinafter known as the "RIDER" and the parents or legal guardian thereof if a minor, do hereby voluntarily request and agree to participate in horse riding or horse instruction on and about EQUINE ESCAPES, and that RIDER will ride a horse provided to him or her by EQUINE ESCAPES by RIDER'S own arrangement, today and on all future dates:

B. SCOPE OF AGREEMENT AND DEFINITIONS: This agreement shall be legally binding upon me, the RIDER, and the parents or guardians thereof if a minor, my heirs, estate, assigns, including all minor children, and parental representatives. This agreement shall be interpreted according to the laws of the State of Washington. Any disputes by the RIDER shall be subject to paragraph K below and litigated in the county in which Equine Escapes is physically located. If any clause, phrase or word is in conflict with the laws of the State of Washington then that single part is null and void. The term "HORSE" herein shall refer to all equine species. The term "RIDING” or "HORSEBACK RIDING" herein shall refer to riding, instruction in, or otherwise handling of or being near horses, ponies, mules, or donkeys whether from the ground or mounted. The term "RIDER" shall herein refer to a person who rides a horse or otherwise handles or comes near a horse from the ground. The terms "I", "me", and "my" shall herein refer to the above RIDER and the parents or legal guardians thereof if a minor.

C. INHERENT RISK OF ACTIVITY: I understand that horseback riding is a rugged recreational activity and that there are numerous obvious and non-obvious inherent risks always present in such activities despite all safety precautions. As such, related injuries can be severe or even deadly and, at the least, can require more hospital days and result in more lasting residual effects than injuries from most other activities. Further, this inherent risk is of a horse that has been used for or is considered usable for the instruction of beginners. Horse accidents are common and, in fact, are virtually guaranteed to occur given enough time around horses. Horse accidents are even more common with beginners although expert riders are still subject to considerable (sometimes fatal) danger from participation in this activity.

D. NATURE OF RIDING HORSES: I understand that EQUINE ESCAPES chooses its horses for their calm disposition and sound training as required for use as riding horses for our riding programs yet, no horse is a completely safe horse. If a horse is frightened or irritated it may divert from any training it has received and act according to its natural survival instincts which may include but are not limited to: stopping short, changing directions or speed at will, shifting its weight, kicking, biting, running under obstacles, or running from danger.

E. RIDER RESPONSIBILITY: I understand that, notwithstanding the presence or participation of an instructor or trainer, upon mounting a horse and taking up the reins, the RIDER is in primary control of the horse. The RIDER'S safety largely depends upon his or her ability to carry out simple instructions, and his or her ability to remain balanced aboard the moving animal (which is not easy for beginners). The RIDER shall be responsible for his or her own safety and that of an unborn child if the rider is pregnant. Pregnant women should ride horses only under the advice of their physician. EQUINE ESCAPES advises pregnant women NOT to ride horses.

F. CONDITIONS OF NATURE: EQUINE ESCAPES is not responsible for total or partial acts, occurrences, or elements of nature that can scare a horse, cause it to fall, or otherwise react in some unsafe way. SOME EXAMPLES ARE: thunder, lightning, rain, wind, wild and domestic animals, insects, or reptiles which may walk, run, fly near, bite and/or sting a horse or person. Further, EQUINE ESCAPES is not responsible for irregular or obstructed footing on groomed or wild land (including indoor or outdoor arenas, pens, or pastures), which is subject to constant change in condition according to use, weather, temperature, maintenance (or lack thereof) and natural and man-made changes in landscape. Further still, EQUINE ESCAPES is not responsible for activities engaged in by others such as, but not limited to, hunters (shooting guns, for example), or car drivers or occupants (honking horns or throwing objects to scare a horse, for example).

G. ACCIDENTAL AND PERSONAL LIABILITY INSURANCE: I agree that should medical treatment be required, I and/or my own accidental/medical insurance company shall pay for all such incurred expenses and deductibles. Should my actions cause injury or damage of any kind, I and/or my own personal liability insurance company shall pay for such damages.

H. PROTECTIVE HEADGEAR WARNING: I agree that for myself and on behalf of my child and/or legal ward have been fully warned and advised by EQUINE ESCAPES that an ASTM/SEI approved helmet should be worn while riding and being near horses and I do understand that the 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 the result of a fall and other occurrences.

I. MEDICAL RELEASE: I certify that I am in good health and do not have any medical history or current conditions that would interfere or prevent my exposure to equines or any equine activities. I understand that any equine related activity may aggravate previous medical conditions and it is my responsibility to disclose all allergies and medical conditions below.

K. LIABILITY RELEASE: I agree that in consideration of EQUINE ESCAPES allowing my participation in this activity under the terms set forth herein, I, the RIDER, for myself and on behalf of my child and/or legal ward or other parent, heirs, administrators, personal representatives or assigns, do agree to hold harmless, release, and discharge EQUINE ESCAPES, its owners, agents, independent contractors, employees, officers, directors, representatives, assigns, members, owners of premises and trails (whether or not such premises or trails are owned by EQUINE ESCAPES, affiliated organizations and insurers and others acting on its behalf (hereinafter, collectively referred to as "Associates") of and from all claims, demands, causes of action and legal liability, whether your damage be known or unknown, anticipated or unanticipated due to EQUINE ESCAPES's and/or its Associate's ordinary negligence; and I do further agree that except in the event of EQUINE ESCAPES's gross negligence and willful and wanton misconduct, I shall not bring any claims, demands, legal actions and causes of action, against EQUINE ESCAPES and its Associates as stated above in this clause, for any economic and non-economic losses due to bodily injury, death, property damage, sustained by me and/or my minor child or legal ward in relation to the premises and operations of EQUINE ESCAPES, to include while riding, handling, or otherwise being near horses owned by or in the care custody and control of EQUINE ESCAPES, whether on or off the premises of EQUINE ESCAPES.

L. ATTORNEY'S FEES: I agree that in consideration of EQUINE ESCAPES allowing my participation in this activity under the terms set forth herein agrees to indemnify EQUINE ESCAPES and its Associates for all reasonable attorneys fees and related costs incurred in defending themselves against any compensatory actions taken or threatened by the Rider, the parents or guardians thereof, or his or her heirs, estate, assigns, including all minor children, and parental representatives. As much as we enjoy making our horses available to various riders (paying or otherwise), we respectfully request that if Rider believes that a horse-related personal injury or death (apart from EQUINE ESCAPES's willful and gross negligence) is justifiable grounds for shifting any part of the financial, emotional, and physical burdens of his or her injury (as onerous, regrettable, and/or tragic as they may be) back to EQUINE ESCAPES or its Associates, then please do not participate in this activity with our horses. Thank you.

All riders and parents or legal guardians must sign below after reading this entire document:

SIGNER STATEMENT OF AWARENESS I/WE, THE UNDERSIGNED, HAVE READ AND DO UNDERSTAND THE FOREGOING AGREEMENT, WARNINGS, RELEASE AND ASSUMPTION OF RISK. WE FURTHER ATTEST THAT ALL FACTS RELATING TO THE APPLICANT ARE TRUE AND ACCURATE

Today's Date: September 20, 2020

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information
MEDICAL RELEASE: Please check all that apply
Dizziness or fainting spells
Back pain
Heart problems
Hip or knee pain
Upper extremity pain
Diabetes
Blindness or visual impairment
Hearing impairment
Neuropathy
High or low blood pressure
Recent sprains or fractures
Allergies (bees, dander, pollen, grass)
Carry an inhaler
Currently pregnant
Seizures
Other

If other
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Information
MEDICAL RELEASE: Please check all that apply
Dizziness or fainting spells
Back pain
Heart problems
Hip or knee pain
Upper extremity pain
Diabetes
Blindness or visual impairment
Hearing impairment
Neuropathy
High or low blood pressure
Recent sprains or fractures
Allergies (bees, dander, pollen, grass)
Carry an inhaler
Currently pregnant
Seizures
Other

If other
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Information
MEDICAL RELEASE: Please check all that apply
Dizziness or fainting spells
Back pain
Heart problems
Hip or knee pain
Upper extremity pain
Diabetes
Blindness or visual impairment
Hearing impairment
Neuropathy
High or low blood pressure
Recent sprains or fractures
Allergies (bees, dander, pollen, grass)
Carry an inhaler
Currently pregnant
Seizures
Other

If other
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information
MEDICAL RELEASE: Please check all that apply
Dizziness or fainting spells
Back pain
Heart problems
Hip or knee pain
Upper extremity pain
Diabetes
Blindness or visual impairment
Hearing impairment
Neuropathy
High or low blood pressure
Recent sprains or fractures
Allergies (bees, dander, pollen, grass)
Carry an inhaler
Currently pregnant
Seizures
Other

If other
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information
MEDICAL RELEASE: Please check all that apply
Dizziness or fainting spells
Back pain
Heart problems
Hip or knee pain
Upper extremity pain
Diabetes
Blindness or visual impairment
Hearing impairment
Neuropathy
High or low blood pressure
Recent sprains or fractures
Allergies (bees, dander, pollen, grass)
Carry an inhaler
Currently pregnant
Seizures
Other

If other
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information
MEDICAL RELEASE: Please check all that apply
Dizziness or fainting spells
Back pain
Heart problems
Hip or knee pain
Upper extremity pain
Diabetes
Blindness or visual impairment
Hearing impairment
Neuropathy
High or low blood pressure
Recent sprains or fractures
Allergies (bees, dander, pollen, grass)
Carry an inhaler
Currently pregnant
Seizures
Other

If other
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information
MEDICAL RELEASE: Please check all that apply
Dizziness or fainting spells
Back pain
Heart problems
Hip or knee pain
Upper extremity pain
Diabetes
Blindness or visual impairment
Hearing impairment
Neuropathy
High or low blood pressure
Recent sprains or fractures
Allergies (bees, dander, pollen, grass)
Carry an inhaler
Currently pregnant
Seizures
Other

If other
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information
MEDICAL RELEASE: Please check all that apply
Dizziness or fainting spells
Back pain
Heart problems
Hip or knee pain
Upper extremity pain
Diabetes
Blindness or visual impairment
Hearing impairment
Neuropathy
High or low blood pressure
Recent sprains or fractures
Allergies (bees, dander, pollen, grass)
Carry an inhaler
Currently pregnant
Seizures
Other

If other
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information
MEDICAL RELEASE: Please check all that apply
Dizziness or fainting spells
Back pain
Heart problems
Hip or knee pain
Upper extremity pain
Diabetes
Blindness or visual impairment
Hearing impairment
Neuropathy
High or low blood pressure
Recent sprains or fractures
Allergies (bees, dander, pollen, grass)
Carry an inhaler
Currently pregnant
Seizures
Other

If other
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information
MEDICAL RELEASE: Please check all that apply
Dizziness or fainting spells
Back pain
Heart problems
Hip or knee pain
Upper extremity pain
Diabetes
Blindness or visual impairment
Hearing impairment
Neuropathy
High or low blood pressure
Recent sprains or fractures
Allergies (bees, dander, pollen, grass)
Carry an inhaler
Currently pregnant
Seizures
Other

If other
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Emergency Contact

Emergency Contact's 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.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information
MEDICAL RELEASE: Please check all that apply
Dizziness or fainting spells
Back pain
Heart problems
Hip or knee pain
Upper extremity pain
Diabetes
Blindness or visual impairment
Hearing impairment
Neuropathy
High or low blood pressure
Recent sprains or fractures
Allergies (bees, dander, pollen, grass)
Carry an inhaler
Currently pregnant
Seizures
Other

If other
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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