Loading...

Waiver

WAIVER, RELEASE AND INDEMNIFICATION AGREEMENT WITH COVENANT NOT TO SUE


To induce Patchwork Farm, LLC, Patchwork Property, LLC, Janet Salem, Lauren Hulen Kissel, LHK Training and Sales, LLC, Quinn Larimer,  ANG Equestrian LLC, Aimee Gahl, Hannah Gannon and WTS INC, their agents, servants and employees (all of said parties are hereinafter collectively called the “Indemnified Parties”) to allow the use of the facilities at the property located at 153 Beavers Road, Canton, GA 30115 and known as Patchwork Farm (the “Property”) and in consideration of the use of the same, the undersigned, by executing this writing, agrees to hold harmless, discharge, release, and indemnify the Indemnified Parties with respect to any and all claims, causes of action, injuries, damages, costs, expenses and losses of any one or more of the Indemnified Parties (including, but not limited to, reasonable attorneys’ fees) arising out of or in any way connected with any activities at the Property or use of the facilities at the Property or use of the facilities at the Property by myself, my spouse, my family, my children, my friends, the rider indicated at the end of this form and/or guest spectators accompanying any of said persons to the Property. The foregoing indemnity includes, but is not limited to, any and all damage, loss, or injury of any kind to any horse or other property or person (whether on or off the facilities of the Property and whether or not any such liability, damage, cost or loss shall be due to acts or omissions of any one or more of the Indemnified Parties) and for all losses, costs, claims, injuries, damages, expenses and causes of action arising out of any use of the facilities of the Property, of riding horses on or off the facilities of the Property,  and of boarding horses with or at the Property.

The undersigned acknowledges the inherent risks associated with the sport of equestrian without limitation including serious bodily injury, sickness and disease (including communicable diseases), pain and suffering, permanent disability, paralysis and death arising out of the unpredictable behavior of horses.

Further, the undersigned AGREES NOT TO SUE or pursue any legal or equitable action against any one or more of the Indemnified Parties with respect to any claims, causes of action, injuries, damages, costs or expenses, or losses to myself, my spouse, my family, my children, my friends, the rider indicated at the end of this form and/or guest spectators accompanying any of the above persons to the Property arising out of or in any way connected with the use of the facilities of the Property. Said covenant not to sue shall include, but not be limited to, any and all damage, loss or injury of any kind to my horse(s) or other property or persons (whether on or off the facilities of the Property, and whether any such liabilities, damage, cost or loss shall be due to acts or omissions of one or more of the Indemnified Parties). In addition, the Indemnified Parties shall not be liable for any loss due to accident, illness, fire, or theft. It is the responsibility of the undersigned to carry full and complete insurance coverage on his horse, personal property and himself.

Further, the undersigned acknowledges and agrees that the activities on and about the Property include horses which may, from time to time, become “spooked” and cause damage or injury to the rider, other persons and property. The undersigned hereby acknowledges that he or she is knowledgeable about the risks of such animals and assumes the risk of any injury or damage caused by any horse on or about the Property.

 

WARNING

UNDER GEORGIA LAW, AN EQUINE ACTIVITY SPONSOR OR EQUINE PROFESSIONAL IS NOT LIABLE FOR ANY INJURY TO OR THE DEATH OF A PARTICIPANT IN EQUINE ACTIVITIES RESULTING FROM THE INHERENT RISKS OF EQUINE ACTIVITIES PURSUANT TO CHAPTER 12 OF TITLE 4 OF THE OFFICIAL CODE OF GEORGIA ANNOTATED.

Signed this day of date: December 30, 2024

First Rider's Name

First Name*

Last Name*

Phone*
First Rider's Age Acknowledgment*
First Rider's Date of Birth*
I certify that I am 18 years of age or older
First Rider's Signature*
Second Rider's Name

First Name*

Last Name*
Second Rider's Date of Birth*
Third Rider's Name

First Name*

Last Name*
Third Rider's Date of Birth*
Fourth Rider's Name

First Name*

Last Name*
Fourth Rider's Date of Birth*
Fifth Rider's Name

First Name*

Last Name*
Fifth Rider's Date of Birth*
Sixth Rider's Name

First Name*

Last Name*
Sixth Rider's Date of Birth*
Seventh Rider's Name

First Name*

Last Name*
Seventh Rider's Date of Birth*
Eighth Rider's Name

First Name*

Last Name*
Eighth Rider's Date of Birth*
Ninth Rider's Name

First Name*

Last Name*
Ninth Rider's Date of Birth*
Tenth Rider's Name

First Name*

Last Name*
Tenth Rider's Date of Birth*
Parent or Guardian's Email Address

Email
Your signed waiver will be sent to the email address provided here and is available for download for three days via URL attachment.
Rider's 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:*
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*

Phone*
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 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!