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Waiver & Release for participation in activities at Lockwood Park, a facility of the Rockford Park District. 

EQUINE PROGRAM WAIVER & RELEASE

 

IMPORTANT INFORMATION

The Rockford Park District is committed to conducting its recreation programs and activities in a safe manner and holds the safety of participants in high regard. The Rockford Park District continually strives to reduce such risks and insists that all participants follow safety rules and instructions that are designed to protect the participant's safety. However, participants and parents/guardians of minors registering for this program must recognize that there is an inherent risk of injury when choosing to participate in recreational activities.

You are solely responsible for determining if you or your minor child/ward is physically fit and/or adequately skilled for the activities contemplated by this agreement. It is always advisable, especially if the participant is pregnant, disabled in any way or recently suffered an illness, injury or impairment, to consult a physician before undertaking any physical activity.

 
WARNING OF RISK

Equine activities are intended to engage the physical, mental and emotional resources of each participant. Despite careful and proper preparation, instruction, medical advice, conditioning and equipment, there is still a risk of serious injury, including head/brain injury, spinal cord injury, and bone and joint injuries. All hazards and dangers cannot be foreseen. Certain inherent risks include the propensity of an equine to behave in dangerous ways that may result in injury to the participant, including, but not limited to the inability to predict an equines reaction to sound, movements, objects, persons, or animals and actions by the equine due to fright, anger, stress, insect bites or natural reactions such as bucking, jumping sideways, forward or backwards, kicking, and biting. Other risks include losing balance, falling off the horse, surface or subsurface conditions, acts of God, inclement weather, slips and falls, poor mounting, dismounting or riding technique, horseplay, riding into fixed objects and being knocked off the horse, equipment failure, failure in instruction/supervision, and all other risks inherent in equine activities. In this regard, it must be recognized that it is impossible for the Rockford Park District to guarantee absolute safety.

 

WAIVER AND RELEASE OF ALL CLAIMS AND ASSUMPTION OF RISK

 Please read this form carefully and be aware that in signing up and participating in this program/activity, you will be expressly assuming the risk and legal liability and waiving and releasing all claims for injuries, damages or loss which you or your minor child/ward might sustain as a result of participating in any and all activities connected with and associated with this program/activity (including transportation services and vehicle operations, when provided).

 I recognize and acknowledge that there are certain risks of physical injury to participants in this program/activity, and I voluntarily agree to assume the full risk of any and all injuries, damages or loss, regardless of severity, that my minor child/ward or I may sustain as a result of said participation. I further agree to waive and relinquish all claims I or my minor child/ward may have (or accrue to me or my child/ward) as a result of participating in this program/activity against the Rockford Park District, including its officials, agents, volunteers and employees.

 I have read and fully understand the above important information, warning of risk, assumption of risk and waiver and release of all claims. If registering on-line or via fax, my on-line or facsimile signature shall substitute for and have the same legal effect as an original form signature.

First Participant's Name

First Name*

Last Name*
First Participant's Age Acknowledgment*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
First Participant's Guardian/Ward of Adult Participant
Select if you are a Guardian / Ward signing on behalf of an Adult Participant

Guardian / Ward First and Last Name
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Guardian/Ward of Adult Participant
Select if you are a Guardian / Ward signing on behalf of an Adult Participant

Guardian / Ward First and Last Name
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Guardian/Ward of Adult Participant
Select if you are a Guardian / Ward signing on behalf of an Adult Participant

Guardian / Ward First and Last Name
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Guardian/Ward of Adult Participant
Select if you are a Guardian / Ward signing on behalf of an Adult Participant

Guardian / Ward First and Last Name
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Guardian/Ward of Adult Participant
Select if you are a Guardian / Ward signing on behalf of an Adult Participant

Guardian / Ward First and Last Name
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Guardian/Ward of Adult Participant
Select if you are a Guardian / Ward signing on behalf of an Adult Participant

Guardian / Ward First and Last Name
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Guardian/Ward of Adult Participant
Select if you are a Guardian / Ward signing on behalf of an Adult Participant

Guardian / Ward First and Last Name
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Guardian/Ward of Adult Participant
Select if you are a Guardian / Ward signing on behalf of an Adult Participant

Guardian / Ward First and Last Name
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Guardian/Ward of Adult Participant
Select if you are a Guardian / Ward signing on behalf of an Adult Participant

Guardian / Ward First and Last Name
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Guardian/Ward of Adult Participant
Select if you are a Guardian / Ward signing on behalf of an Adult Participant

Guardian / Ward First and Last Name
Parent or Guardian's Email Address

Email
A signed copy of this waiver will be sent to the email address you provide.
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*

Last Name*
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Guardian/Ward of Adult Participant
Select if you are a Guardian / Ward signing on behalf of an Adult Participant

Guardian / Ward First and Last Name
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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