Name *

First Name

Last Name

Date *

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Please Check Each Box *

By signing this form, I hereby acknowledge on behalf of myself that I have familiarized myself with the activities that I will be allowed to participate in, and that I do hereby acknowledge and agree that I will participate in these activities without restriction or limitation. I recognize the inherent risks involved in riding and working with horses, including but not limited to:

Bites, kicks, abrasions or contusions from horses that can result in significant injury or death

Being thrown or bucked off by horses with resulting injury or death

Scratches or other injury from stalls or enclosures.

Scratches or other injury from grooming tools and other equine equipment and tack.

Allergic reactions to animals, hay, or other allergens.

Tripping in holes or on materials or equipment.

Slipping, falling, or otherwise being injured in the barn, in stalls, or on the grounds, which can be slippery, muddy, wet, or contain or present other hazards that can cause injury or even death

Waive & Release *

I hereby specifically forever waive and release Laurie Weiser and its principals and agents from any liability for injury arising out of the inherent risks from riding, working or participating in a stable environment and/or with horses, as well as from the active negligence of Laurie Weiser 756 Epps Clark Rd, Siler City, NC 27344 its principals and agents.

I Agree

Supervision *

By signing this agreement I hereby acknowledge that there may NOT be supervision during my time spent at 756 Epps Clark Rd, Siler City, NC 27344, NOR will there be a nurse or medical professional on the premises and Laurie Weiser and its principals and agents bear no responsibility for my health or medical care.

I Agree

Indemnify *

I agree to indemnify, save and hold harmless Laurie Weiser and its principals and agents from and against any loss, liability, damage, attorneys’ fees, or costs that they may incur arising out of or in any way connected with either my presence or participation at 756 Epps Clark Rd Siler City, NC 27344 or any acts or omissions of Laurie Weiser principals or agents.

I Agree

Understanding *

By signing this Agreement, and by initialing the paragraph below, I hereby acknowledge my complete understanding, agreement and consent to my presence and/or participation in the activities at Laurie Weiser 756 Epps Clark Rd, Siler City, NC 27344, without restriction, without liability to Laurie Weiser its principals or agents, and with full knowledge and understanding of the disclosures, waivers, and releases herein.

I Agree

Risk *

If I am present at and participate in the activities at 756 Epps Clark Rd, Siler City, NC 27344 I do so at my own risk, and I hereby acknowledge and agree that Laurie Weiser and/or any of its principals and agents shall bear no responsibility or risk associated with injuries that could arise from my presence or participation at 756 Epps Clark Rd, Siler City, NC 27344

I Agree

Date Signed *

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