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Wings of Hope Ranch

2021 Trail Ride at Millstone Farm 

Saturday, November 6th from 9am-4pm

Participant Release / Waiver

The following waiver must be signed online or a completed paper copy brought to check in - along with a current, negative Coggins Certificate for your horse. Coggins can be emailed to development@wingsofhoperanch.org ; please include rider's first and last name and the horse's name.

The sponsors of this equine activity, Wings of Hope Ranch, lnc., as well as any of our volunteers or any other persons or organizations involved with this event, including Millstone Farm, and the owner of Millstone Farm, William Grubb, shall not be liable for an injury to or death of a participant resulting from the intrinsic dangers of equine activities. No participant, nor any participant's parent, guardian or representative shall have or make any claim against or recover from any equine activity sponsor, equine professional or any other person for injury, loss, damage, or death of the participant resulting from any of the intrinsic dangers of equine activities. "lntrinsic dangers of equine activities" means those dangers or conditions that are an integral part of equine activities, including but not limited to (i) the propensity of equines 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 such things as sounds, sudden movement, 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. ln consideration of the sponsor allowing me (or rny child) to attend this event, I agree to assume all risks specifically enumerated herein. I UNDERSTAND THAT THIS MEANS THAT I AGREE NOT TO SUE ANY OR ALL OF THE RELEASED PARTIES in connection with the event. This waiver shall remain valid unless expressly revoked in writing by the participant or parent or guardian of a minor. Required riding attire includes heeled hard-sole, enclosed toe shoe / boot and Iong pants. HELMETS ARE REQUIRED TO BE WORN BY ALL WHILE RIDING.

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 Information
Do you have an up to date/current Coggins*
No
Yes

Horse Name *

COGGINS TEST DATE *

STATE COGGINS TEST WAS PERFORMED *

LAB ASCENSION NUMBER *
You understand a copy of Coggins certificate is required.*
No
Yes

Email coggins to development@wingsofhoperanch.org along with the rider/registrant's name and the horse's name.

Directions to Millstone Farm: 10600 Cosby Mill Road, Quinton, VA 23141. Take 64 East to Exit 205/VA'33W towards VA-249E/US-60/Bottoms Bridge/Quinton. Turn left onto VA-33 E & continue onto New Kent Hwy US 249 E/New Kent CH. Travel a short distance, just after the Wendy's Restaurant, turn LEFT onto Dispatch Rd (Rt. 613), then take an immediate RIGHT onto S Quaker Rd. (Rt. 6LL), stay on S. Quaker for 2 miles. Turn RIGHT onto Cosby Mill Rd (Rt. 638) and go 2 miles. The entrance to Millstone Farm is on the left. 

Staff will be at entrance to greet you and collect / inspect your coggins certificate and collect any payments due.

Thank you!

First Participant's Signature*
Second Participant's Name

First Name*

Last Name*

Phone*
Second Participant's Date of Birth*
Second Participant's Information
Do you have an up to date/current Coggins*
No
Yes

Horse Name *

COGGINS TEST DATE *

STATE COGGINS TEST WAS PERFORMED *

LAB ASCENSION NUMBER *
You understand a copy of Coggins certificate is required.*
No
Yes

Email coggins to development@wingsofhoperanch.org along with the rider/registrant's name and the horse's name.

Directions to Millstone Farm: 10600 Cosby Mill Road, Quinton, VA 23141. Take 64 East to Exit 205/VA'33W towards VA-249E/US-60/Bottoms Bridge/Quinton. Turn left onto VA-33 E & continue onto New Kent Hwy US 249 E/New Kent CH. Travel a short distance, just after the Wendy's Restaurant, turn LEFT onto Dispatch Rd (Rt. 613), then take an immediate RIGHT onto S Quaker Rd. (Rt. 6LL), stay on S. Quaker for 2 miles. Turn RIGHT onto Cosby Mill Rd (Rt. 638) and go 2 miles. The entrance to Millstone Farm is on the left. 

Staff will be at entrance to greet you and collect / inspect your coggins certificate and collect any payments due.

Thank you!

Third Participant's Name

First Name*

Last Name*

Phone*
Third Participant's Date of Birth*
Third Participant's Information
Do you have an up to date/current Coggins*
No
Yes

Horse Name *

COGGINS TEST DATE *

STATE COGGINS TEST WAS PERFORMED *

LAB ASCENSION NUMBER *
You understand a copy of Coggins certificate is required.*
No
Yes

Email coggins to development@wingsofhoperanch.org along with the rider/registrant's name and the horse's name.

Directions to Millstone Farm: 10600 Cosby Mill Road, Quinton, VA 23141. Take 64 East to Exit 205/VA'33W towards VA-249E/US-60/Bottoms Bridge/Quinton. Turn left onto VA-33 E & continue onto New Kent Hwy US 249 E/New Kent CH. Travel a short distance, just after the Wendy's Restaurant, turn LEFT onto Dispatch Rd (Rt. 613), then take an immediate RIGHT onto S Quaker Rd. (Rt. 6LL), stay on S. Quaker for 2 miles. Turn RIGHT onto Cosby Mill Rd (Rt. 638) and go 2 miles. The entrance to Millstone Farm is on the left. 

Staff will be at entrance to greet you and collect / inspect your coggins certificate and collect any payments due.

Thank you!

Fourth Participant's Name

First Name*

Last Name*

Phone*
Fourth Participant's Date of Birth*
Fourth Participant's Information
Do you have an up to date/current Coggins*
No
Yes

Horse Name *

COGGINS TEST DATE *

STATE COGGINS TEST WAS PERFORMED *

LAB ASCENSION NUMBER *
You understand a copy of Coggins certificate is required.*
No
Yes

Email coggins to development@wingsofhoperanch.org along with the rider/registrant's name and the horse's name.

Directions to Millstone Farm: 10600 Cosby Mill Road, Quinton, VA 23141. Take 64 East to Exit 205/VA'33W towards VA-249E/US-60/Bottoms Bridge/Quinton. Turn left onto VA-33 E & continue onto New Kent Hwy US 249 E/New Kent CH. Travel a short distance, just after the Wendy's Restaurant, turn LEFT onto Dispatch Rd (Rt. 613), then take an immediate RIGHT onto S Quaker Rd. (Rt. 6LL), stay on S. Quaker for 2 miles. Turn RIGHT onto Cosby Mill Rd (Rt. 638) and go 2 miles. The entrance to Millstone Farm is on the left. 

Staff will be at entrance to greet you and collect / inspect your coggins certificate and collect any payments due.

Thank you!

Fifth Participant's Name

First Name*

Last Name*

Phone*
Fifth Participant's Date of Birth*
Fifth Participant's Information
Do you have an up to date/current Coggins*
No
Yes

Horse Name *

COGGINS TEST DATE *

STATE COGGINS TEST WAS PERFORMED *

LAB ASCENSION NUMBER *
You understand a copy of Coggins certificate is required.*
No
Yes

Email coggins to development@wingsofhoperanch.org along with the rider/registrant's name and the horse's name.

Directions to Millstone Farm: 10600 Cosby Mill Road, Quinton, VA 23141. Take 64 East to Exit 205/VA'33W towards VA-249E/US-60/Bottoms Bridge/Quinton. Turn left onto VA-33 E & continue onto New Kent Hwy US 249 E/New Kent CH. Travel a short distance, just after the Wendy's Restaurant, turn LEFT onto Dispatch Rd (Rt. 613), then take an immediate RIGHT onto S Quaker Rd. (Rt. 6LL), stay on S. Quaker for 2 miles. Turn RIGHT onto Cosby Mill Rd (Rt. 638) and go 2 miles. The entrance to Millstone Farm is on the left. 

Staff will be at entrance to greet you and collect / inspect your coggins certificate and collect any payments due.

Thank you!

Sixth Participant's Name

First Name*

Last Name*

Phone*
Sixth Participant's Date of Birth*
Sixth Participant's Information
Do you have an up to date/current Coggins*
No
Yes

Horse Name *

COGGINS TEST DATE *

STATE COGGINS TEST WAS PERFORMED *

LAB ASCENSION NUMBER *
You understand a copy of Coggins certificate is required.*
No
Yes

Email coggins to development@wingsofhoperanch.org along with the rider/registrant's name and the horse's name.

Directions to Millstone Farm: 10600 Cosby Mill Road, Quinton, VA 23141. Take 64 East to Exit 205/VA'33W towards VA-249E/US-60/Bottoms Bridge/Quinton. Turn left onto VA-33 E & continue onto New Kent Hwy US 249 E/New Kent CH. Travel a short distance, just after the Wendy's Restaurant, turn LEFT onto Dispatch Rd (Rt. 613), then take an immediate RIGHT onto S Quaker Rd. (Rt. 6LL), stay on S. Quaker for 2 miles. Turn RIGHT onto Cosby Mill Rd (Rt. 638) and go 2 miles. The entrance to Millstone Farm is on the left. 

Staff will be at entrance to greet you and collect / inspect your coggins certificate and collect any payments due.

Thank you!

Seventh Participant's Name

First Name*

Last Name*

Phone*
Seventh Participant's Date of Birth*
Seventh Participant's Information
Do you have an up to date/current Coggins*
No
Yes

Horse Name *

COGGINS TEST DATE *

STATE COGGINS TEST WAS PERFORMED *

LAB ASCENSION NUMBER *
You understand a copy of Coggins certificate is required.*
No
Yes

Email coggins to development@wingsofhoperanch.org along with the rider/registrant's name and the horse's name.

Directions to Millstone Farm: 10600 Cosby Mill Road, Quinton, VA 23141. Take 64 East to Exit 205/VA'33W towards VA-249E/US-60/Bottoms Bridge/Quinton. Turn left onto VA-33 E & continue onto New Kent Hwy US 249 E/New Kent CH. Travel a short distance, just after the Wendy's Restaurant, turn LEFT onto Dispatch Rd (Rt. 613), then take an immediate RIGHT onto S Quaker Rd. (Rt. 6LL), stay on S. Quaker for 2 miles. Turn RIGHT onto Cosby Mill Rd (Rt. 638) and go 2 miles. The entrance to Millstone Farm is on the left. 

Staff will be at entrance to greet you and collect / inspect your coggins certificate and collect any payments due.

Thank you!

Eighth Participant's Name

First Name*

Last Name*

Phone*
Eighth Participant's Date of Birth*
Eighth Participant's Information
Do you have an up to date/current Coggins*
No
Yes

Horse Name *

COGGINS TEST DATE *

STATE COGGINS TEST WAS PERFORMED *

LAB ASCENSION NUMBER *
You understand a copy of Coggins certificate is required.*
No
Yes

Email coggins to development@wingsofhoperanch.org along with the rider/registrant's name and the horse's name.

Directions to Millstone Farm: 10600 Cosby Mill Road, Quinton, VA 23141. Take 64 East to Exit 205/VA'33W towards VA-249E/US-60/Bottoms Bridge/Quinton. Turn left onto VA-33 E & continue onto New Kent Hwy US 249 E/New Kent CH. Travel a short distance, just after the Wendy's Restaurant, turn LEFT onto Dispatch Rd (Rt. 613), then take an immediate RIGHT onto S Quaker Rd. (Rt. 6LL), stay on S. Quaker for 2 miles. Turn RIGHT onto Cosby Mill Rd (Rt. 638) and go 2 miles. The entrance to Millstone Farm is on the left. 

Staff will be at entrance to greet you and collect / inspect your coggins certificate and collect any payments due.

Thank you!

Ninth Participant's Name

First Name*

Last Name*

Phone*
Ninth Participant's Date of Birth*
Ninth Participant's Information
Do you have an up to date/current Coggins*
No
Yes

Horse Name *

COGGINS TEST DATE *

STATE COGGINS TEST WAS PERFORMED *

LAB ASCENSION NUMBER *
You understand a copy of Coggins certificate is required.*
No
Yes

Email coggins to development@wingsofhoperanch.org along with the rider/registrant's name and the horse's name.

Directions to Millstone Farm: 10600 Cosby Mill Road, Quinton, VA 23141. Take 64 East to Exit 205/VA'33W towards VA-249E/US-60/Bottoms Bridge/Quinton. Turn left onto VA-33 E & continue onto New Kent Hwy US 249 E/New Kent CH. Travel a short distance, just after the Wendy's Restaurant, turn LEFT onto Dispatch Rd (Rt. 613), then take an immediate RIGHT onto S Quaker Rd. (Rt. 6LL), stay on S. Quaker for 2 miles. Turn RIGHT onto Cosby Mill Rd (Rt. 638) and go 2 miles. The entrance to Millstone Farm is on the left. 

Staff will be at entrance to greet you and collect / inspect your coggins certificate and collect any payments due.

Thank you!

Tenth Participant's Name

First Name*

Last Name*

Phone*
Tenth Participant's Date of Birth*
Tenth Participant's Information
Do you have an up to date/current Coggins*
No
Yes

Horse Name *

COGGINS TEST DATE *

STATE COGGINS TEST WAS PERFORMED *

LAB ASCENSION NUMBER *
You understand a copy of Coggins certificate is required.*
No
Yes

Email coggins to development@wingsofhoperanch.org along with the rider/registrant's name and the horse's name.

Directions to Millstone Farm: 10600 Cosby Mill Road, Quinton, VA 23141. Take 64 East to Exit 205/VA'33W towards VA-249E/US-60/Bottoms Bridge/Quinton. Turn left onto VA-33 E & continue onto New Kent Hwy US 249 E/New Kent CH. Travel a short distance, just after the Wendy's Restaurant, turn LEFT onto Dispatch Rd (Rt. 613), then take an immediate RIGHT onto S Quaker Rd. (Rt. 6LL), stay on S. Quaker for 2 miles. Turn RIGHT onto Cosby Mill Rd (Rt. 638) and go 2 miles. The entrance to Millstone Farm is on the left. 

Staff will be at entrance to greet you and collect / inspect your coggins certificate and collect any payments due.

Thank you!

Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive our monthly e-newsletter and volunteer opportunities by e-mail.
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 Information
Do you have an up to date/current Coggins*
No
Yes

Horse Name *

COGGINS TEST DATE *

STATE COGGINS TEST WAS PERFORMED *

LAB ASCENSION NUMBER *
You understand a copy of Coggins certificate is required.*
No
Yes

Email coggins to development@wingsofhoperanch.org along with the rider/registrant's name and the horse's name.

Directions to Millstone Farm: 10600 Cosby Mill Road, Quinton, VA 23141. Take 64 East to Exit 205/VA'33W towards VA-249E/US-60/Bottoms Bridge/Quinton. Turn left onto VA-33 E & continue onto New Kent Hwy US 249 E/New Kent CH. Travel a short distance, just after the Wendy's Restaurant, turn LEFT onto Dispatch Rd (Rt. 613), then take an immediate RIGHT onto S Quaker Rd. (Rt. 6LL), stay on S. Quaker for 2 miles. Turn RIGHT onto Cosby Mill Rd (Rt. 638) and go 2 miles. The entrance to Millstone Farm is on the left. 

Staff will be at entrance to greet you and collect / inspect your coggins certificate and collect any payments due.

Thank you!

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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