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Firefly Horse Co. Wellness Retreat Center

Waiver and Release for Equine & Animal Related Activities

Please read the following carefully and indicate your understanding and agreement to these statements by signing below.

I understand and believe that the use, handling, or riding of a horse & other animals involves a risk of physical injury. I further know that any horse and/or animals upon the property, regardless of its training and usual past behavior may act or react unpredictably at any time. With full awareness of the foregoing, I am knowingly and voluntarily engaging in equine activities and/or other animal activities sponsored by Firefly Horse Co. (FHC), their employees, or any of its’ subcontractors. The possibility of injury to myself is accepted as a risk inherent in work with or activities around horses and other animals present; this includes but is not limited to any equipment or arenas / property used in activities with horses and animals that may be present.

I understand that safety in working with horses and misc. animals, whether riding or on the ground, requires mental alertness and a moderate degree of physical fitness.  

I agree to abide by and follow facility rules and regulations which are posted on site.

It is recommended that all riders wear protective helmets, which are provided onsite for your convenience. It is REQUIRED that any child younger than 18 years of age MUST wear a helmet when riding. It is my understanding that a helmet is available and has been offered for my own or my child’s safety.

I also understand that I must and will use my own judgement where the situation demands it. I understand that all equine & all animal activities are entirely voluntary and that I may elect not to comply with any suggested act. FHC, any of its’ subcontractors, and other participants, are entitled to my good faith efforts to respond to the exercise directives, but are not entitled to nor expect absolute obedience. It is expected that I will be alert and thinking at all times while engaged in equine & all animal activities.

I have read and understand Montana Code Annotated for Horse Use.

TITLE 27. CIVIL LIABILITY, REMEDIES, AND LIMITATIONS

CHAPTER 1. AVAILABILITY OF REMEDIES -- LIABILITY

Part 7. Liability - Equine Activity Liability Limitations

27-1-727. Equine activity liability limitations. (1) Except as provided in subsections (2) and (3), an equine activity sponsor or an equine professional is not liable for an injury to or the death of a participant engaged in an equine activity resulting from risks inherent in equine activities.

(2) An equine participant shall act in a safe and responsible manner at all times to avoid injury to the participant and others and to be aware of risks inherent in equine activities.

(3) Subsection (1) does not apply:

(a) if the equine activity sponsor or the equine professional:

(i) provided the equipment or tack and the equipment or tack caused the injury because the equine activity sponsor or equine professional failed to reasonably and prudently inspect or maintain the equipment;(ii) provided the equine and failed to make reasonable and prudent efforts to determine the ability of the participant to safely engage in the equine activity and the participant's ability to safely manage the particular equine based on the participant's representations as to the participant's ability;

(iii) owned, leased, rented, or otherwise was in lawful possession and control of the land or facilities upon which the participant sustained injuries caused by a dangerous latent condition that was known or should have been known to the equine activity sponsor or the equine professional;

(iv) committed an act or omission that constituted willful or wanton disregard for the safety of the participant and the act or omission caused the injury; or

(v) intentionally injured the participant; or

(b) in a products liability action.

In consideration of the potential learning and growth value of equine & other animal activities, I the undersigned expressly and voluntarily assume the unavoidable risks inherent in horse related activities mounted and dismounted, as well as other misc. animal related activities. I do hereby release, discharge and hold harmless Firefly Horse Co., LLC and any of its’ subcontractors, including but not limited to Firefly Healing Arts, LLC and Montana Horseworks, LLC from any and all claims which I, the undersigned, or my assigns, may assert as a result of physical injury or loss of property incurred while using, handling or riding a horse, as well as other animal interactions as part of equine & other animal activities on this date or other dates as part of continuing horse & animal use.   

My signature on this form constitutes expression of my understanding and agreement to all statements above and my total and unconditional release of Firefly Horse Co and any of its’ subcontractors along with any co-workers or assignsassociated with equine activities.

Date: April 27, 2024

First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information

I am notifying FHC or any of its' subcontractors of any conditions or limitations that impair my physical mobility or compromise my ability to remain alert and thinking at all times while engaged in equine & other animal facilitated activities and exercises. Please list here:

My photo may be taken and used for newspaper articles or the Firefly website, Facebook and other medias.  Please write "I decline" if you do not agree with your photo being used for advertising.


If you do not want your picture, video, or other media used for any social media, marketing, or other purposes please write "I Decline" in this box.
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

Last Name*
Second Participant's Date of Birth*
Second Participant's Information

I am notifying FHC or any of its' subcontractors of any conditions or limitations that impair my physical mobility or compromise my ability to remain alert and thinking at all times while engaged in equine & other animal facilitated activities and exercises. Please list here:

My photo may be taken and used for newspaper articles or the Firefly website, Facebook and other medias.  Please write "I decline" if you do not agree with your photo being used for advertising.


If you do not want your picture, video, or other media used for any social media, marketing, or other purposes please write "I Decline" in this box.
Third Participant's Name

First Name*

Middle Name

Last Name*
Third Participant's Date of Birth*
Third Participant's Information

I am notifying FHC or any of its' subcontractors of any conditions or limitations that impair my physical mobility or compromise my ability to remain alert and thinking at all times while engaged in equine & other animal facilitated activities and exercises. Please list here:

My photo may be taken and used for newspaper articles or the Firefly website, Facebook and other medias.  Please write "I decline" if you do not agree with your photo being used for advertising.


If you do not want your picture, video, or other media used for any social media, marketing, or other purposes please write "I Decline" in this box.
Fourth Participant's Name

First Name*

Middle Name

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information

I am notifying FHC or any of its' subcontractors of any conditions or limitations that impair my physical mobility or compromise my ability to remain alert and thinking at all times while engaged in equine & other animal facilitated activities and exercises. Please list here:

My photo may be taken and used for newspaper articles or the Firefly website, Facebook and other medias.  Please write "I decline" if you do not agree with your photo being used for advertising.


If you do not want your picture, video, or other media used for any social media, marketing, or other purposes please write "I Decline" in this box.
Fifth Participant's Name

First Name*

Middle Name

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information

I am notifying FHC or any of its' subcontractors of any conditions or limitations that impair my physical mobility or compromise my ability to remain alert and thinking at all times while engaged in equine & other animal facilitated activities and exercises. Please list here:

My photo may be taken and used for newspaper articles or the Firefly website, Facebook and other medias.  Please write "I decline" if you do not agree with your photo being used for advertising.


If you do not want your picture, video, or other media used for any social media, marketing, or other purposes please write "I Decline" in this box.
Sixth Participant's Name

First Name*

Middle Name

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information

I am notifying FHC or any of its' subcontractors of any conditions or limitations that impair my physical mobility or compromise my ability to remain alert and thinking at all times while engaged in equine & other animal facilitated activities and exercises. Please list here:

My photo may be taken and used for newspaper articles or the Firefly website, Facebook and other medias.  Please write "I decline" if you do not agree with your photo being used for advertising.


If you do not want your picture, video, or other media used for any social media, marketing, or other purposes please write "I Decline" in this box.
Seventh Participant's Name

First Name*

Middle Name

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information

I am notifying FHC or any of its' subcontractors of any conditions or limitations that impair my physical mobility or compromise my ability to remain alert and thinking at all times while engaged in equine & other animal facilitated activities and exercises. Please list here:

My photo may be taken and used for newspaper articles or the Firefly website, Facebook and other medias.  Please write "I decline" if you do not agree with your photo being used for advertising.


If you do not want your picture, video, or other media used for any social media, marketing, or other purposes please write "I Decline" in this box.
Eighth Participant's Name

First Name*

Middle Name

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information

I am notifying FHC or any of its' subcontractors of any conditions or limitations that impair my physical mobility or compromise my ability to remain alert and thinking at all times while engaged in equine & other animal facilitated activities and exercises. Please list here:

My photo may be taken and used for newspaper articles or the Firefly website, Facebook and other medias.  Please write "I decline" if you do not agree with your photo being used for advertising.


If you do not want your picture, video, or other media used for any social media, marketing, or other purposes please write "I Decline" in this box.
Ninth Participant's Name

First Name*

Middle Name

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information

I am notifying FHC or any of its' subcontractors of any conditions or limitations that impair my physical mobility or compromise my ability to remain alert and thinking at all times while engaged in equine & other animal facilitated activities and exercises. Please list here:

My photo may be taken and used for newspaper articles or the Firefly website, Facebook and other medias.  Please write "I decline" if you do not agree with your photo being used for advertising.


If you do not want your picture, video, or other media used for any social media, marketing, or other purposes please write "I Decline" in this box.
Tenth Participant's Name

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information

I am notifying FHC or any of its' subcontractors of any conditions or limitations that impair my physical mobility or compromise my ability to remain alert and thinking at all times while engaged in equine & other animal facilitated activities and exercises. Please list here:

My photo may be taken and used for newspaper articles or the Firefly website, Facebook and other medias.  Please write "I decline" if you do not agree with your photo being used for advertising.


If you do not want your picture, video, or other media used for any social media, marketing, or other purposes please write "I Decline" in this box.
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*

Middle Name

Last Name*

Relationship*

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

I am notifying FHC or any of its' subcontractors of any conditions or limitations that impair my physical mobility or compromise my ability to remain alert and thinking at all times while engaged in equine & other animal facilitated activities and exercises. Please list here:

My photo may be taken and used for newspaper articles or the Firefly website, Facebook and other medias.  Please write "I decline" if you do not agree with your photo being used for advertising.


If you do not want your picture, video, or other media used for any social media, marketing, or other purposes please write "I Decline" in this box.
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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